Every new patient is required to fill out the “New Patient Forms”.  Please fill out the forms that are required, depending on your status and insurance.

We offer copies of our paperwork online to save you time.  If you would prefer, you can always arrive 15 minutes early for your scheduled appointment to complete the paperwork in our office.

The following forms can be brought with you to your appointment or submit via email at comcarechiro@gmail.com.

New Patient Forms:

New Patient Intake Form

Health Questionnaire

Privacy Policy (only need to read, print if you would like paper copy for YOUR records only)

Privacy Policy Signature Page (to be submitted acknowledging you read the Privacy Policy)

HIPAA Contact & Personal Release

Medicare Patient Forms:

Advanced Beneficiary Notice

Neck Index (for neck and headache complaints)

Low Back Index (for low back complaints only)

If you have both neck and low back complaints, please complete both index forms.

Worker’s Compensation Forms:

Workers’ Compensation Questionnaire

Responsibility of Payment Form

Neck Index (for neck and headache complaints)

Low Back Index (for low back complaints only)

If you have both neck and low back complaints, please complete both forms.

No-Fault or Auto-Accident Forms:

Auto-Accident Questionnaire

Assignment of Benefits Form

If you have any questions along the way, feel free to call the office at 716-580-3577.