Shepherd Chiro Clinic

For you convenience, the following forms are provided for you to complete prior to your appointment

New Patient Intake Form

Complete if you are a NEW or newly returning patient and need to update your personal or employer information.

Patient Health Questionnaire

Complete if you are a NEW patient or an ESTABLISHED patient with NEW health issues.

Lower Back Index

Complete for all BCBS, Auto and Work injury claims. This questionnaire provides information about how your back condition affects your everyday life.

Neck Index

Complete for all BCBS, Auto and Work injury claims. This questionnaire provides information about how your neck condition affects your everyday life.

Auto and Personal Injury Checklist

Complete this form if you have or will file an auto or personal injury claim.

Workers Comp Checklist

Complete this form if you have or will file a workers comp claim.