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Chiropractic Treatment Consent Form

Asks about chief complaint, areas to be treated, and treatment techniques. Built for obtaining informed consent before spinal adjustments or cervical manipulation.

Questions
12
Pages
2
Time
about 3 min

Includes

  • E-signature
  • Consent agreement
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Your practice

Chiropractic Treatment Consent Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Obtaining informed consent before spinal adjustments or cervical manipulation
  • Documenting patient understanding of risks including vertebrobasilar stroke
  • Recording treatment area and technique authorization for chiropractic care
  • Screening for pregnancy and other contraindications to manipulation

What's inside

Before you publish: Add your practice-approved consent wording before publishing.

Page 1 · Your information

  1. Patient Full NameText · Required
  2. Date of BirthDate
  3. Chief ComplaintLong Text
  4. Areas to Be TreatedLong Text
  5. Treatment TechniquesLong Text

Page 2 · Additional details

  1. Risks of Spinal Manipulation AcknowledgedLong Text
  2. Consent to Diagnostic Imaging if NeededLong Text
  3. Right to Withdraw Consent AcknowledgedConsent Agreement
  4. Consent to TreatmentConsent Agreement
  5. Patient SignatureE-Signature

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Chiropractic Treatment Consent Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Chiropractic Treatment Consent Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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