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CHIROPRACTIC INTAKE & HISTORY PATIENT Information Patient Name LAST Damage Birthday Partners Name MIDDLE Headdress Suburb Occupation FIRST NAME Emergency Contact (name & number):Post Code Mobile Phone

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How to fill out chiropractic intake history

01

Step 1: Start by gathering all necessary personal and medical information of the patient.

02

Step 2: Begin with basic personal details such as name, age, gender, and contact information.

03

Step 3: Ask about the patient's medical history, including any past injuries, surgeries, or illnesses.

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Step 4: Inquire about the patient's current symptoms or pain they are experiencing.

05

Step 5: Ask about any current medications or supplements the patient is taking.

06

Step 6: Obtain information regarding the patient's lifestyle and habits, such as exercise routines or dietary habits.

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Step 7: Gather information about the patient's family medical history.

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Step 8: Provide a detailed section for the patient to describe their chief complaint or reason for seeking chiropractic care.

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Step 9: Include specific sections to document the patient's range of motion, strength, and neurological testing results.

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Step 10: Finally, ensure all information is accurately recorded, and review the intake history to identify any potential red flags.

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Step 11: Make sure the patient signs and dates the intake history form to acknowledge the accuracy of the provided information.

Who needs chiropractic intake history?

01

Chiropractic intake history is necessary for anyone seeking chiropractic care.

02

It is particularly crucial for new patients who have never been treated by a chiropractor before.

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Having a comprehensive intake history helps chiropractors understand the patient's medical background, current condition, and any potential risk factors.

04

This information allows chiropractors to develop personalized treatment plans and ensure safe and effective care.

05

Both adults and children can benefit from a detailed chiropractic intake history.

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What is chiropractic intake history?

Chiropractic intake history is a comprehensive document that collects information about a patient's medical history, current conditions, lifestyle, and any previous treatments or surgeries to assist the chiropractor in understanding the patient's needs and tailoring their care.

Who is required to file chiropractic intake history?

Patients seeking chiropractic care are required to fill out the chiropractic intake history prior to their first appointment to provide the chiropractor with necessary background information.

How to fill out chiropractic intake history?

To fill out chiropractic intake history, patients should accurately provide detailed responses to each question regarding their health history, current symptoms, medications, and lifestyle choices. It's important to be honest and thorough to ensure effective care.

What is the purpose of chiropractic intake history?

The purpose of chiropractic intake history is to gather essential health information that enables chiropractors to assess the patient's condition, identify any potential issues, and create a personalized treatment plan.

What information must be reported on chiropractic intake history?

Chiropractic intake history must report personal information including medical history, current health issues, medications, any prior treatments, lifestyle habits, and family health history.

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