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Exclusive Offer

New Patients Receive a Free Consultation

Online Forms

Basin Family Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • 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 form(s) or bring it with you to your appointment.


SELF PAY AND INSURANCE PATIENT PAPERWORK

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!

Are we billing you insurance? Please bring in your card as well.

Download & Print Form


MEDICARE PATIENT PAPERWORK

Would you like us to bill Medicare for you?  Please fill out this paperwork, and bring it in with you to your first appointment, along with your Medicare card and secondary insurance if you have it.

Download & Print Forms


L&I PATIENT PAPERWORK

File an L&I Claim - Want to save some time? Complete your Report of Accident online and bring in your email with your claim number.

Download & Print Forms


AUTO ACCIDENT PAPERWORK

Involved in a car accident?  Save some time and fill out these forms prior to your first appointment.

Download & Print Forms


MASSAGE PATIENT PAPERWORK

Please print out and complete these forms prior to your first massage.  Also, please bring in your referral if we are billing your insurance.

Download & Print Forms



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