Chiropractic intake needs to go deeper than generic medical history: the spine, the musculoskeletal system, and the daily habits behind a patient's condition. A good form gives you that picture before the exam starts.
Contact Information and Demographics
Name, date of birth, address, phone, email, emergency contact, employer. Add occupation and daily work activities: a construction worker and an accountant with the same complaint often have different causes.
Chief Complaint and Pain Assessment
- Primary complaint, in their own words
- When it started, and gradual onset vs. a specific incident
- Pain location, as a checklist of body regions with left/right
- Pain scale (0-10) at rest, with movement, and at worst
- Pain quality: sharp, dull, aching, radiating, burning
- Frequency: constant, intermittent, only with certain activities
- What makes it better and worse
Radiating pain matters most. Low back pain that shoots down the leg is a different picture from localized lumbar pain. Make "Does your pain radiate to other areas?" a conditional question that opens fields for the radiation pattern.
Spinal and Musculoskeletal History
- Previous chiropractic care (where, when, techniques, outcomes)
- Spinal surgeries or injections
- Herniated or bulging discs
- Scoliosis
- Fractures, especially vertebral
- Neck or back injuries from accidents, falls, or sports
- Orthotics, braces, or supports
Knowing which techniques were used before (Diversified, Activator, Gonstead, Thompson) and whether they worked shapes your approach right away.
Accident and Injury History
Many patients come in after an auto accident or workplace injury:
- Auto accident details (date, position in vehicle, speed, direction of impact)
- Workers' compensation status
- Slip and fall incidents
- Sports injuries
- Claim number and attorney information, if applicable
Show these fields only when the patient selects "auto accident" or "workplace injury".
Lifestyle and Ergonomic Factors
- Work: sitting vs. standing, desk setup, repetitive motion, heavy lifting
- Activity: exercise type and frequency
- Sleep: position and mattress age
- Stress: drives muscle tension and posture
- Screen time: relevant for cervical complaints
Imaging History
Prior X-rays, MRI, or CT of the area: when, where, and findings. Add a file upload for patients who have digital copies.
Medical History and Medications
Medications, supplements, allergies, and conditions. Flag osteoporosis, inflammatory arthritis, cancer history, and clotting disorders: they're contraindications or precautions for certain adjustments.
Treatment Goals
Pain relief, mobility, posture, a return to a specific activity? Documented goals set shared expectations and measurable outcomes.
Consent
Informed consent for chiropractic treatment, including adjustment risks, with an e-signature.
Putting It Together
Formisoft's AI builder drafts a chiropractic intake form covering these sections in seconds. Use conditional logic for accident and workers' comp fields, and split the form into pages.
Patients complete it on their phone before the first visit, you review it before the exam, and the appointment focuses on the patient. That's patient readiness: every form attached to the visit done before the patient walks in.
See how Formisoft gets every patient ready before the visit.
Intake forms built for your specialty, ready before the visit.
- Forms, consents, and signatures before the visit
- Your paper forms converted by AI
- BAA included