Perrault Chiropractic Offices, Inc.
Chiropractic care - It's a healthy way of living for the entire family.
You Can Submit Your Paperwork Online!!!
Save Time! Complete forms before your Appointment!
The best way of doing your intake paperwork is by submitting your information by a secure online form.
This online form is extensive and requires about 20 minutes to complete. The more detailed and complete you are in filling out the form, the more efficient your appointment will be. Do Not use the backspace key to move backwards in the form, it will delete all your input. At the end of the form be sure to click the Submit button. Get started by clicking the link below.
If you are completing the online form you DO NOT have to download and print out the paperwork below.
You can also download, print and complete paperwork at your convenience.
If you have not completed an online form, all new patients should download and complete the The New Patient Packet. If you were involved in an automobile accident you will also need to download and complete the Auto Injury Questionnaire.
Please fill out all forms completely and in detail. Completed forms can be:
Adobe Acrobat Reader is required to view and print these forms. It's FREE, just click the link below.
All New Patient Download This Packet.
Most new patients need only to download and complete this packet of forms, instructions are included. If you have been in an automobile injury, you will also need to download and complete the Auto Injury Questionnaire below.
Patient Insurance Form - Changes in Insurance
If you have had a change in your Insurance Policy or Insurance Company, please download and complete this form.
Problem Detail Form - For Returning Patients
If it's been more than three months since we've seen you - or if you have a new condition, please download and complete this form in detail. Use only one form for each problem you are having. For instance, if you have been having a neck and a low back problem, fill out individual forms for each of these problem areas.
Auto Injury Questionnaire
If you are seeking treatment for injuries sustained in an automobile accident, please download and complete this form. The form also contains important information on the documents you need to bring to the office.
United Healthcare and Great-West Patients
If you have one of these two plans you may be required to fill out a special forms required by your insurance carrier. These forms include a Patient Health Questionnaire, Neck Index and Back Index. All patients with these plans should fill out the Patient Health Questionnaire. Each patient should then choose the appropriate Neck or Back Index, you can fill out both forms if your problem extends to both areas of your spine.