Chiropractic Intake Form

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A successful chiropractor must give patients the utmost care and attention, ensuring a great experience from the first visit. To achieve the best results when meeting new patients, it is crucial to comprehend the patient as a whole, not just their present condition. This is why it's essential to obtain a medical history and collect all important information you need ahead of time.

You can use a chiropractic intake form to get to know your patients more so that you can individually personalize each session to meet their needs and assist them in achieving their highest level of health and wellbeing. By asking these simple, straightforward questions, you'll streamline the onboarding process for both you and your patients. If you want to create your own intake form, read on to find out more about what it is and the elements you should cover.

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What Is a Chiropractic Patient Intake Form?

A chiropractic intake form is a digital or physical form that the patient must fill out before having a chiropractic treatment. This enables the chiropractor to identify the patient's needs and better prepare his or her treatment plan. These forms help make decisions that are safe for the client's present health status by using their medical history to educate yourself on diagnoses, prior diseases, and drugs.

Additionally, a new patient intake form will give you an opportunity to get to know a patient beyond just their formal medical history. You can learn a lot about a patient's family history and develop a picture of their general health state by learning about their lifestyle. This may include their current living circumstances, jobs, daily schedule, hobbies, and diet.

What Information Should Be Included in Chiropractic Intake Forms?

For the patient and the chiropractor to effectively collaborate, the patient intake form must clarify and clearly specify all parameters, medical information, habits and current health issues. Let's go over the essential data that you need to gather for your new patient intake forms.

Personal and Contact Information

You must fill out the first section of the form with all pertinent details about your patient that will be needed if you need to get in touch with them. You should ask the following personal questions on your form:

- Full name

- Date of Birth

- Marital Status

- Employment status

- Phone number

- Email address

Medical Information

You will be able to give your patient the best diagnosis and course of treatment if they disclose their medical history before beginning treatment with you. Select your questions carefully because you don't want the form to be too lengthy and you want to learn as much as you can about their health. Here are some basics you can consider.

- Purpose of the visit

- Existing medical conditions

- A list of any surgeries

- Allergies

- Pregnancy or breastfeeding

- Smoking, drinking or illegal substances

- A history of injuries

- Previous hospitalizations

- Current medications


Inquiring about your patient's lifestyle and daily activities will enable you to provide straightforward lifestyle suggestions that could improve their health. Here are some questions you can include in this section.

- How often do you exercise each week?

- What kind of work do you do?

- How stressful do you consider your job to be?

- Do you think you're in good health?

- How frequently do you eat out?

- How many hours do you sleep each night?

- How many glasses of water do you consume each day?

Insurance information

Finally, you can include a section to inquire about the client's insurance details, or whether they will be paying for your services in full or installments. Usually patients are required to provide their insurance card and the most basic insurance policy details which also helps streamline the registration process and maintain client profiles organized.

Create Your Chiropractic Intake Form Template With Bonsai

With Bonsai's custom client forms, you can easily create professional patient intake forms and share them via email, URL link or have them embedded into your website if you want to increase leads. Our forms are fully customizable so you can add as many questions as you need, select your desired answer format and even add your business branding elements to make it your own.

Need more help? Bonsai can help you streamline your end-to-end processes with complete invoicing features, payment processing, taxes, accounting and more. Start your 14-day free trial today and see for yourself!

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