New Patient Forms

Welcome to Parkway Chiropractic! 

To make your first visit as smooth as possible, please complete the necessary forms before your appointment. This will help us provide the best care for you without any delays.

Forms Required for All New Patients:

• Patient Financial Agreement:

  Download

  Required for all patients.

• X-Ray Refusal Form:

  Download

  Only if you do not wish to receive an X-ray.

• Patient Information Form

  Download

  Required to gather your basic information.

Additional Forms

• DOT Physical:

  Download

  If you need a DOT physical, please complete the personal information section of the Medical Examination Report Form.

• Auto Accident Patients

  If you were involved in an auto accident, please complete the following:

         • Patient Financial Lien Form
         • Information Needed for Personal Injury Worksheet
         • Personal Injury Questionnaire

  If you have any questions about which forms to complete, please call us at (623) 537-3900.
  
  
  We look forward to helping you on your journey to better health!
  

  - Dr. Glenn Micheels and the Team at Parkway Chiropractic