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DR. ANN LIZARD, B.COMM, DC DOCTOR OF CHIROPRACTIC 4353 HASTINGS STREET BURNABY, BC V5C 2J7 TEL: 604.293.2941 FAX: 604.298.2941 WWW.BHIHC.COM WWW.ANNIZARD.COM CHIROPRACTIC NEW PATIENT FORM FULL NAME:

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How to fill out bhihc chiropractic intake form

How to fill out a BHIHC chiropractic intake form:

01

Start by providing your personal information. This includes your full name, date of birth, address, contact number, and email. These details are necessary for the chiropractor to identify you and reach out to you if needed.

02

Next, you may be asked to provide your medical history. This includes any previous illnesses or injuries, surgeries, medications you are currently taking, and any known allergies. Be honest and thorough in providing this information as it helps the chiropractor understand your health background better.

03

The form may also ask about your current symptoms or issues. Describe in detail the reason for seeking chiropractic care, such as back pain, neck stiffness, headaches, or any other concerns. Include information about when the symptoms started and any factors that may have triggered them.

04

You may be asked to indicate whether you have had any prior chiropractic treatments or if you are currently receiving care from another healthcare professional. It is essential to communicate this information accurately to ensure coordinated and safe treatment.

05

The intake form might have a section that addresses your lifestyle and habits. You may be asked about your occupation, daily activities, exercise routine, and diet. These questions help the chiropractor assess any lifestyle factors that could be contributing to your condition or impacting your overall health.

06

Lastly, the form may contain some consent and agreement statements. Read through these statements carefully and sign them if you understand and agree to the terms and conditions. These statements typically cover matters like privacy, billing, and clinic policies.

Who needs a BHIHC chiropractic intake form?

Anyone seeking chiropractic care from a BHIHC (Board of Holistic Integrated Health Care) certified chiropractor will need to fill out the intake form. This form allows the chiropractor to gather essential information about the patient's health history, current symptoms, and lifestyle. By knowing these details, the chiropractor can create a tailored treatment plan that addresses the patient's specific needs and concerns. The intake form also serves as a legal document for both the patient and the chiropractor, ensuring transparency and mutual understanding in the therapeutic relationship.

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What is bhihc chiropractic intake form?

The bhihc chiropractic intake form is a document used by chiropractic clinics to gather essential information about new patients.

Who is required to file bhihc chiropractic intake form?

New patients visiting a chiropractic clinic are required to fill out the bhihc chiropractic intake form.

How to fill out bhihc chiropractic intake form?

Patients can fill out the bhihc chiropractic intake form by providing accurate personal and medical information requested on the form.

What is the purpose of bhihc chiropractic intake form?

The purpose of the bhihc chiropractic intake form is to collect important information about the patient's health history and current symptoms to assist the chiropractor in providing appropriate care.

What information must be reported on bhihc chiropractic intake form?

The bhihc chiropractic intake form typically requests information about the patient's medical history, current symptoms, allergies, medications, and contact information.

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