New Patient Information Packet

  1. New Patient Information, Financial & Communications Policy, and HIPPA Notice (PDF) -

    Download and Read

New Patient Paperwork

  1. New Patient Paperwork (PDF) - Download, Print, Fill Out, and Sign

HIPAA RESTRICTION OF CONSENT

  1. HIPAA Restriction of Consent Form - Download, Print, Fill Out, and Sign

PATIENT INSURANCE INFORMATION

  1. Out-of-Network Chiropractic Benefit Verification Courtesy Form (PDF) - Download, Print, and Fill Out

CONSENT TO TREATMENT OF A MINOR

  1. Consent to Treatment of a Minor (PDF) - Download, Print, Fill Out, and Sign

AUTHORIZATION TO RELEASE MEDICAL INFORMATION

  1. Authorization to Release Medical Information (PDF) - Download, Print, Fill Out, and Sign

Accident Paperwork

  1. Accidental Injury Report (PDF) - Download, Print, Fill Out, and Sign

  2. Accidental Injury Insurance Information (PDF) - Download, Print, and Fill Out

  3. New Patient Paperwork (PDF) - Download, Print, Fill Out, and Sign

If you have been in an accident, you will need to fill out the two accident forms in addition to a new set of new patient paperwork even if you are already a current patient at Morter HealthCenter. 

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New Patient Information Packet