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 Form
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.
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.
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.
Sports Physical Health History
IF you are scheduling a sports physical, 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 simple write the athelete's name and Date of Birth at the top of the Examination Page.
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: firstname.lastname@example.org
2) Print the completed form and bring it with you to your sports physical visit.
You may also choose to print a copy of the Health History and fill it in by hand:
Print Version of Physical: Download & Print Forms
PI 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.