Moore Health Chiropractic Wellness Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Bring the completed form(s) with you to your first appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with?

All new patients need to complete the History Form. If you have a Worker's Comp or Personal injury claim you also will need to complete the corresponding form below.

Download & Print Form

Worker's Compensation Policy and Patient Form

For Workers Compensation claims we are required to have verification of the injury with a superior at your employer. We will have you fill out a workers compensation questionnaire about your injury and your job requirements, and information on where to send the bills.

You will also need to complete the Patient History form above.

Download & Print Form

Personal Injury Policy and Patient Form

If you have been involved in an Auto Accident and wish to bill auto insurance for your services we will need several pieces of information: (1) your car insurance information, (2) your group health information, (3) a copy of the accident report, and (4) information on the third party insurance. Our office policy is to bill your auto policy’s medical payments portion and or your major medical insurance. We will not bill and wait for payment from a third party or attorney.

You will also need to complete the Patient History form above.

Download & Print Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!