New Patient Forms

Are you a new patient at Back-in-Action? We’d be delighted if before your visit you could download these forms and fill in the details about your problem (Chiropractic New Patient Registration – Adult) and your medical history (Chiropractic New Patient Medical History Form – Adult). If you’ve had a road traffic accident please can you also fill out our Accident Report Questionnaire. Most of these forms are a bit of a marathon but it’s worth the effort because they provide us with loads of useful information to help you get better.

Before we can start treatment, we need your informed consent. Please download the form and have read through. If you are happy and have no further questions, please bring it with you signed on your first visit.

We have specific forms for younger children – Chiropractic New Patient Registration – Children.

Please click on the form to download the document…

Chiropractic New Patient Registration - Adult
Chiropractic New Patient Registration – Adult
Chiropractic New Patient Medical History
Chiropractic New Patient Medical History
Traffic Accident Report Questionnaire
Traffic Accident Report Questionnaire
Informed Consent
Informed Consent
Chiropractic New Patient Registration - Child
Chiropractic New Patient Registration – Child

From the Preston Chiropractor Team
Getting You Back in Action & Enjoying Your Life Again
Serving the people of Preston and surrounding areas including Southport and Lytham St Annes