Patient Forms
Welcome to our paperless office!
Our office strives daily to operate as greenly as possible. Here are just a few reasons why we have minimized our paper use.
- 42% of the industrial wood harvest is used to make paper.
- Paper accounts for 25% of landfill waste (and one third of municipal landfill waste).
- 28% of paper produced is copy or print paper, which is reponsibe for 20 million metric tons of carbon dioxide released into the atmosphere
- If the United States cut office paper use by just 10% it would prevent the emission of 1.6 million tons of greenhouse gases -- the equivalent of taking 280,000 cars off the road.
- The pulp and paper industry is the third largest contributor to global emmisions, which does not include the emissions from the logging process or shipping of the final product.
Prior to your New patient or Re-evaluation visit, please complete the appropriate forms located below.
The forms are located on a HIPPA compliant, secure link and are submitted directly to our office. These electronic forms allow us to create your intra-office electronic patient file, therefore eliminating the need for paper.Instructions:
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All new patients must fill out the Patient Information Form.
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If you have Neck Pain or other related conditions such as: headaches, pain located from the skull to the top of the shoulders or radiating pain in the arms or hands; please select the Neck Pain Form below.
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If you have Lower Back Pain or other related conditions such as: pain located between the bra line and the beltline, buttock pain, Sacroiliac pain, outer thigh pain, or radiating pain in the legs or feet; please select the Low Back Pain form below.
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If you were involved in a Motor Vehicle Collision and are seeking treatment for a condition or symptoms related to that collision please select the Motor Vehicle Collision History Form below.
PATIENT FORMS:

Patient Experiences
By far the best practice! Everyone in the office genuinely cares and makes you feel like family. I drive over 30 minutes to see Dr. B and will never change! Thank you Back Solutions Chiropractic Center! EB