Intake Form

Initial paperwork in 3 easy steps.

Step 1 - Print the appropriate intake form and fill it out.
Step 2 - Print, read and sign the Informed Consent for Chiropractic Care form, the X-Ray
Consent form and the HIPPA Notice of Privacy Practices  
Step 3 - Fax them to us at (360) 802-0731, or you can bring them in when you come
into the office.

The intake form is in Adobe Acrobat format, and requires the free download of

Acrobat Reader to view.

Child Intake Form

Adult Intake Form

Informed Consent for Chiropractic Care

X-Ray Consent Form

HIPPA Notice of Privacy Practices

Thank You,

Dr. Gary Smith