New Patient Forms
Click below to download our new patient forms.
Fill out these forms at
home before you come for your first visit!
Welcome to our Inner Balance family!
Congratulations, you have made the first step towards being healthier and improving your life. Following is the initial paperwork required for your first appointment. You are welcome to save time at your appointment by completing the paperwork and faxing it to our office at: 269-556-9735, or bringing it with you to your scheduled visit. Do not hesitate to call us at 256-556-9654 if you have any questions. Dr. Tara and the staff members are here to help you.
- Consent – This form acknowledges your agreement with our privacy policy per the HIPAA regulation; a current copy is always located at the front desk, and we are happy to provide you with a copy upon request.
- Authorization for Contact – This form authorizes us to leave messages regarding appointments or other office information at the telephone numbers you’ve provided.
- Emergency Contact – If we have an emergency and need to close the office unexpectedly and cannot reach you, please list contacts on this form who we contact to give you a message.
- Agreement – This is our appointment and payment policy; please check your preferred payment method.
- Case History – A chiropractic case history is different than any other case history you have probably filled out before. As a chiropractor, Dr. Tara is interested in your spine and nervous system. She’s specifically interested in injuries to your spine that could damage your nervous system and cause the symptoms that brought you to our office. The case history starts with the birth process, your childhood, and you current health. This will help to discover all the spinal injuries you have had in your life. Then you will describe your major complaint, unless you are seeking Wellness Care like many of the other families that come to our office.
