Telehealth visits beginning soon!!!!!!


Patient Forms

 Below are Fairfield Spine and Rehab Center, LLC new patient forms. Prior to your first appointment, please print off, read, and fill out each of these forms to expedite your wait time in the office.  The last form(Insurance Verification) is provided for you to call your insurance company and verify how much chiropractic care and what kind they will cover. Please, do call for your peace of mind and an easy transition to your treatment plan with no added stress. 

Application for Care (pdf)

Download

Complaint (pdf)

Download

Health History pg. 1 (pdf)

Download

Health History pg. 2 (pdf)

Download

Functional Rating Index (FRI) (pdf)

Download

Informed Consent (pdf)

Download

Financial Policy (pdf)

Download

Notice of Privacy Policy (pdf)

Download

Receipt of Privacy Policy (pdf)

Download

Insurance Verification (pdf)

Download

Telehealt Packet (pdf)

Download