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The following forms are our standard patient intake forms for Core Chiropractic and for your convenience are made available here for download. Please choose all 5 forms from the following list, download and print them off and have them completed in either black or blue ink prior to your firts visit. Thank you!

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Office Financial Policy - Required

Download & Print Form


Health and Insurance Portability and Accountability Act - Notice of Privacy Practice - Required

Download & Print Form


Automobile Crash Form - Required

If you have been involved in a car crash and your condition is related to this accident please additionally fill out the following form:

Download & Print Form


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



Download the Free AdobeReader®

Exclusive Offer

Exclusive Offer Image  Looking to Optimize your health:

Schedule your FREE consultation today!
Medicare, Workers Compensation and Auto Claims exempt from this offer.

Sign-up using the form or call us at 208-664-0800 to take advantage of this exclusive offer.

THIS ---->https://core-chiropracticcom.chiromatrixbase.com/online-forms.html

Office Hours

DayMorningAfternoon
Monday9:00am5:30pm
Tuesday9:00am12pm
Wednesday9:00am4:30pm
Thursday9:00am4:30pm
Friday9:00am12:00pm
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00am 9:00am 9:00am 9:00am 9:00am Closed Closed
5:30pm 12pm 4:30pm 4:30pm 12:00pm Closed Closed

Testimonial

Great service! Nice clean office! I love being able to get an appointment fairly quick if I need an adjustment!

Anna M.
Coeur d' Alene, ID

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