New Patient Forms

To save you time please fill out our new patient forms at home before you come for your first visit.  Please select and print out the type of paperwork that best fits your situation.  Fill out the forms with as much detail as possible.

Cash

  1.  Confidential Patient Form
  2.  Health Questionnaire
  3.  Office Fees and Financial Policy
  4.  Terms of Acceptance

Health Insurance and Medicare

  1.  Confidential Patient Form
  2.  Health Questionnaire
  3.  Low Back Questionnaire (if less than 4 weeks)
  4.  Low Back Questionnaire (if more than 4 weeks)
  5.  Neck Pain Questionnaire
  6.  Office Fees and Financial Policy
  7.  Terms of Acceptance

Personal Injury and Auto Accidents

  1.  Confidential Patient Form
  2.  Health Questionnaire
  3.  Auto Injury Questionnaire
  4.  Accident Injury Questionnaire
  5.  Low Back Questionnaire (if less than 4 weeks)
  6.  Low Back Questionnaire (if more than 4 weeks)
  7.  Neck Pain Questionnaire
  8.  Office Fees and Financial Policy
  9.  Terms of Acceptance

Work Injury

  1.  Confidential Patient Form
  2.  Health Questionnaire
  3.  Accident Injury Questionnaire
  4.  Low Back Questionnaire (if less than 4 weeks)
  5.  Low Back Questionnaire (if more than 4 weeks) 
  6.  Neck Pain Questionnaire
  7.  Office Fees and Financial Policy
  8.  Terms of Acceptance

 


Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.




Dr. Steve Yip, 1612 SW Dash Point Road, Federal Way, WA | (253) 835-5678

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Dr. Steve  Asks some important questions of interest to Federal Way residents - Chiropractor Federal Way Dr. Steve Asks...

What's your plan to deal with drug-resistant 'super germs'?
Chiropractors have always been concerned with the indiscriminate use of antibiotics, accelerating the mutation of microbes that make "wonder" drugs increasingly ineffective. My strategy? Do everything possible to bolster my immune system through proper diet, rest, exercise, clean air, pure water and an optimally functioning nervous system with regular chiropractic care.
Can a chiropractor heal?
There's never been a case in which a doctor (chiropractor or otherwise) has formed scar tissue, mended a broken bone or cured a headache. Only you can do that. Turns out you're the doctor! All I do is help remove interferences to your body's healing ability. Ready to get started? Call our office today.