New Patient Forms

Want to save 20 minutes on your first visit?

Click on the video below before clicking the link to fill out the patient paperwork. 

New Patient Form

https://intake.mychirotouch.com/?clinic=CHC0050 

 

Additional information to help us better serve you: (If you provided an email when you scheduled, a copy of this will be emailed to you shortly.)

  • Bring your ID and/or Driver's License with you
  • Bring your insurance card(s) (Please call if you have any insurance questions (913) 299-0276)
  • Fill out our intake paperwork by clicking the link above 
  • Please call the office to confirm your appointment so we can best serve you on your arrival
  • If the reason you are coming in is due to injuries sustained in a recent car accident and you are going to file to your insurance, scroll down further.

 

 

Motor Vehicle Accident specific information:

  • Bring your ID and/or Driver's License with you
  • Bring your auto insurance card (Must be your insurance. We do not bill third party in this office.)
  • Have claim # with your insurance. 
  • If you have an attorney, please give that info
  • If you have been to the hospital or another doctor, let us know if X-rays or images were taken. (If possible, please bring these with)
  • Click the intake link above and when selecting the main reason for visit, be sure to select Auto Accident 
  • Please call the office to confirm your appointment so we can best serve you on your arrival

 

 

 

 

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