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425-775-6986

Westenhaver Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • 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! Please download and print each of these links below.

Intake forms 1

Intake forms 2

Privacy Policy


Please select the following forms below to match your situation - Please choose only one bolded section below.

General Insurance and Self Pay forms - Please print these forms in addition to the intake forms if we will be billing your general health insurance or you will be paying out of your pocket for all services rendered.

General Insurance/Self pay Forms

Group Health- Please print these forms out in addition to the intake forms if we will be billing Group Health insurance for you.

Group Health Forms

Medicare Forms- Please print the following forms out in addition to the intake forms if we will be billing Medicare for you.

Medicare Form 1

Medicare Form 2

Workers Compensation Form - Please print the following forms out in addition to the intake forms if we will be billing a work compensation insurance for you.

Work Compensation Forms

Auto Accident Form - Please print the following forms out in addition to the intake forms if we will be billing for an auto accident for you.

Auto questionnaire

Auto accident forms 1

Auto accident forms 2

 


Massage Therapy Paperwork- Please print the following forms out if you are coming to our office for massage therapy.

Massage therapy intake forms


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Exclusive Offer

Experience a more gentle chiropractic- try our Pro Adjuster today!

Sign-up using the form or call us at 425-775-6986 to make an appointment today!

Office Hours

Day
Monday8:00 - 11:003:00 - 6:00
Tuesday3:00 - 6:00
Wednesday8:00 - 11:003:00 - 6:00
Thursday8:00 - 11:003:00 - 6:00
FridayClosed
SaturdayClosed
SundayClosed
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00 - 11:00 3:00 - 6:00 8:00 - 11:00 8:00 - 11:00 Closed Closed Closed
3:00 - 6:00 3:00 - 6:00 3:00 - 6:00

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