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Appointment Request Form

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Online Forms

Rocky Mountain Chiropractic and Sports Injury offers our patient form(s) online so they can be completed in the convenience of your own home or office.


RMCSIC Intake Packet
Please download and complete this Intake form before your first visit. If you are unable to complete this form in advance, please arrive to your first appointment about 20 minutes early and you are welcome to fill this paperwork out at that time.  If you received forms in the email and filled out all four of the linked forms, you have already completed this paperwork and will not need to print this packet.

Download & Print Forms


X-Ray Release Form
If you had an x-ray, CT Scan or MRI at the hospital or another office since your accident, please fill out the x-ray release form so that we can examine those studies.

Download & Print Forms


Pediatric Health Screening and Consent
If the Chiropractic Care is for a Child, please download and complete the attached child intake and health history so that we may provide your child with the best care possible.

Download & Print Forms


Sports Physical Health History

IF you are scheduling a sports physical, please complete your Health History Information in advance.  Our office will send you an email with the Online Version listed below in Option #1.  You may save and email (PDF is preferred) the completed form or you may complete the printed form and bring it with you to your visit. 

Sports Physical Option #1

ONLINE VERSION (Sports Physical):  sports-physical-health-history-rmcsic-edits.docm

Once you have filled in the Online Version of the Sports Physical Health History you may either:

1) Save the completed form as a PDF file and email it to: info@chiropracticwindsor.com

OR

2) Print the completed form and bring it with you to your sports physical visit.


Sports Physical Option  #2:  You may also choose to print a copy of the Health History and fill it in by hand:

If you do not Option #1 above, use the attached physical form below.  Please download and complete the first page of the attached sports physical health history.  The second page will be filled out by Dr. Hextell during the examination. Please simply write the athlete's name and Date of Birth at the top of the Examination Page.

Print Version of Physical:  Download & Print Forms


Motor Vehicle Accident Patients:   Initial Visit Packet
If you were involved in a motor vehicle accident, you have come to the right place. Please fill out the attached paperwork before your first visit. Be sure to include claim numbers and fill this packet out in detail. It will help make sure you receive the best possible care and that your case is well documented for insurance and attorney purposes. If you had an x-ray, CT Scan or MRI at the hospital or another office since your accident, please fill out the x-ray release form so that we can examine those studies.

Download & Print Forms




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