Patient Forms

We offer our patient forms online so they can be completed in the convenience of your own home or office before you arrive for your appointment.

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed forms at 303.337.1321 or bring it with you to your appointment.


New Patient Health History Form – Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Welcome Form

Provides patient demographic information, emergency contact information, insurance information and office financial policy information.

Download & Print Form


HIPAA Form

Notice of privacy practice summary--this summary discloses how health information about you may be used; for treatment, to obtain payment for treatment with your authorization as required, for administrative purposes, and evaluate the quality of care that you receive.

Download & Print Form


Medical Information Release Form

Used for patient to authorize the release of their medical information such as x-rays, history, diagnosis and treatment.

Download & Print Form


Health Intake Form with Consent Form

Download & Print Form

Prolific Chiropractic, P.C.

Address

2101 S. Blackhawk Street #140,
Aurora, CO 80014

Phone

303.337.1321

Fax

Office Hours

Monday  

10:00 am - 12:00 pm

2:00 pm - 6:00 pm

Tuesday  

10:00 am - 12:00 pm

Wednesday  

2:00 pm - 6:00 pm

Thursday  

10:00 am - 12:00 pm

2:00 pm - 6:00 pm

Friday  

Closed

Saturday  

Closed

Sunday  

Closed