Our popular Adult Intake Form is clean, professional and patient-friendly — making it the perfect first impression for your practice!

More importantly, by streamlining all the pertinent patient info you need to collect onto a single sheet of paper, they’ll make both patients and Docs equally happy by focusing only on the most important, well-organized information you need to lead the conversation about chiropractic and get more patients on a care plan that is right for them.

Each form includes the following sections:

  • Confidential Patient Information
  • Current Health Conditions
  • Top Three Health Goals
  • Chiropractic History
  • Traumas: Physical Injury History
  • Toxins: Chemical & Environmental Exposure
  • Thoughts: Emotional Stresses & Challenges
  • Acknowledgment & Consent

Key Features of all First Impressions Pro Forms:

  • Collects only the most pertinent patient information, making them faster and easier for patients to complete.
  • Organization and layout of information makes them more functional and efficient for chiropractors to find the info they need to recommend proper care.
  • Clean and modern designs – customized with your contact info make them perfect for any practice!

2 reviews for Adult Intake Forms

  1. Grass Lake Chiropractic Center (verified owner)

    We love the different intake forms!

  2. Victoria (verified owner)

    We have been using these intake forms for years and love the flow and questions asked. It really makes patients think a little different about their health when filling it out too, mostly because of questions specific to the Three Ts (thought, traumas, toxins)!

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