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SSalanger Chiropractic
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New patients

Your new-patient forms

Fill this out before your visit so we can get you in and out faster. Takes about 5 minutes. Questions? Call or text (858) 565-8645.

About you
Payment
Why you're here

Where does it hurt? (check all)

Health history

Any of these conditions? (check all)

Photos (optional)

Snap a photo of your insurance card and ID so we can verify benefits before you arrive. You can also bring them in.

Consent

I consent to a chiropractic examination and treatment. I understand the information I've provided is accurate to the best of my knowledge, and I acknowledge receipt of the practice's privacy practices (HIPAA). I understand chiropractic care, like all health care, carries some risks, which my provider will discuss with me.