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818-998-1527 H
H

818-998-1527

Online Forms

Valley 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.

New Patient Forms - Required

These let us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know! All of the following forms are required for new patients.

  1. Intake Form - Download & Print
  2. Intake Form Part II - Download & Print
  3. Informed Consent Form - Download & Print
  4. Assignment of Benefits - Download & Print
  5. Insurance or Cash Form - Download & Print
  6. Medical Prescriptions Form - Download & Print
  7. Financial Policy Agreement - Download & Print
  8. HIPPA Policies - Download & Print (information only, nothing to fill out)

Automobile Accidents and Worker's Compensation

These forms only need to be filled out if you have been in a car accident or had an injury at work.

  1. Auto Accident Questionnaire - Download & Print Form
  2. Workman's Comp Intake - Download & Print Form

Welcome Back Form

If we haven't seen you for more than 6 Months - Download & Print



Download the Free AdobeReader®

Welcome to Valley Chiropractic
Dr. Helle Leap

3D Spine Simulator

 
Launch
 3D Spine Simulator

DayMorningAfternoon
Monday9AM-12PM2 - 6 PM
TuesdayKelly is inClosed
Wednesday9AM-12PM2 - 6 PM
ThursdayKelly is inClosed
Friday9AM-12PM2 - 6 PM
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9AM-12PM Kelly is in 9AM-12PM Kelly is in 9AM-12PM Closed Closed
2 - 6 PM Closed 2 - 6 PM Closed 2 - 6 PM Closed Closed