Better Days Chiropractic |  2600 South Loop West, Suite 620 | Houston | 77054 | Tel: 713.661.7246
Patient Forms
BETTER DAYS chiropractic clinic

Trusted

family-

oriented

clinic

Patient Forms

Please feel free to review these patient forms and information sheets, as

they will provide much information for you before your office visit.  All files

are PDFs.  Download the latest Adobe Acrobat Reader to view them.

You may print and fill out these forms ahead of time and bring them on your first visit.

*** CASH ONLY PATIENT *** 1. New Patient Form 2. Consent to Treat 3. Release of Information 4. No Accident or Work Injury 5. Notice of Privacy Practices 6. Daily Notes (office) 7. Exam (general physical) *** MAJOR MEDICAL INSURANCE PATIENT *** 1. New Patient Form 2. Consent to Treat 3. Release of Information 4. Financial Policy 5. Fee Sheet 6. No Accident or Work Injury 7. Notice of Privacy Practices 8. Daily Notes (office) 9. Exam (general physical) *** AUTO ACCIDENT PATIENT *** 1. New Patient Form 2. Consent to Treat 3. Release of Information 4. Assignment of Benefits 5. Assignment & Lien 6. Power of Attorney 7. Financial Policy 8. Fee Sheet 9. Demo Forms 10. Notice of Privacy Practices 11. Daily Notes (office) 12. Exam (general physical)

Patient Information Sheets

Provided by the American Chiropractic Association

ARTHRITIS   Information on Arthritis, with nutrition and exercise recommendations.

CARPAL TUNNEL   Definition, diagnosis, and treatment information for Carpal Tunnel Syndrome.

HEADACHES   Common causes of headaches, prevention, and treatment.

SPINE HEALTH   Tips for maintaining a healthy spine.

PREGNANCY   Chiropractic health for expecting mothers.