The Marysville Chiropractor to see - Chiropractor Marysville

New Patient Paperwork

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use.

Adult New Patient Forms

New Patient Intake - Female

New Patient Intake - Male



Pediatric New Patient Forms

Pediatric New Patient Information

Infant History Form

Preschool New Patient Information

School Age Child History Form

Consent to Treat a Minor Form

Medical Doctor Referral

HIPAA Notice

New Patient Registration & History



Auto Accidents

If you have been in a car accident recently, please fill out these forms as well:

Accident Injury Form



Insurance

Insurance Questionnaire

If you have United Healthcare, Great West, Nationwide or Golden Rule, your insurance company requires you to fill out additional paperwork. Please print and complete these forms.



Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.



Drs. Patrick and Charita Cooper
16705 Square Drive, Marysville, OH | (937) 642-4400
Search:

Subscribe to our Marysville chiropractic newsletter Free Newsletter

Receive free professional health tips on topics that interest you.
 
 
Select Topics:
Backaches & Sciatica
Headaches & Neck Pain
Wellness Topics
Diet & Nutrition
Exercise & Fitness
Women's Health Issues
Children's Health Issues
Stress Management

Drs. Cooper Asks some important questions of interest to Marysville residents - Chiropractor Marysville Drs. Cooper Asks...

Is a muscle spasm a cause or an effect?
With the knee-jerk use of muscle relaxers, you'd think it was a cause. But it's an effect. Chiropractors know that bones don't move unless muscles move them. And muscles don't contract unless commanded by the nervous system. That's why your nervous system is the focus of our Marysville chiropractic practice.
Why do so many drugs require a prescription?
Because they can be dangerous? I chose a chiropractic career specifically because it avoids artificial means of pain relief. Our Marysville chiropractic practice attracts health-conscious families that prefer a safe and natural solution. Ready to get started? Call our office today.