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).
Before we can start to help you get better, it is important that you are aware of any possible risk or side effects that might be associated with the treatments we use. Please read through our Informed Consent Information. During the COVID outbreak we need to ask your consent for face-to-face treatment. Please read and sign our Consent for Treatment During COVID form.
If you are interested in an online or phone consultation please read our ‘Video or Telehealth Consultation‘ page . There is also a ‘Telehealth Consent‘ document for you to be aware of and sign.
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.
We have specific forms for younger children – Chiropractic New Patient Registration – Children.
Please return these forms to us prior to your consultation if possible or bring the forms you need with you when you come in for your New Patient Consultation. They are a bit of a marathon so we recommend filling them in gradually. Probably if you were pushed they might take 20-30 minutes to fill them in properly.
Please click on the form to download the document…
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