Download Online Patient Forms
Save time on your first visit by downloading, filling out, and bringing your intake forms with you to your appointment.
General & New Patient Intake
General Patient Intake Form
Standard adult registration, health history, and emergency contact details.
Adult New Patient Form
Detailed lifestyle, musculoskeletal symptoms, and health review.
Chiropractic New Patient Form
Chiropractic-specific case history and consent form.
Auto Injury & Whiplash (MVA)
Motor Vehicle Accident (MVA) Assessment
Collision mechanics, impact direction, and acute symptoms questionnaire.
Alberta AB-2 Treatment Plan Form
Diagnostic and treatment notification form for Alberta Section B auto insurers.
Neck Pain Disability Index
Validated clinical assessment measuring neck injury impact on daily activities.
Low Back Pain Disability Index (Oswestry)
Clinical questionnaire tracking lumbar spine disability progression.
Specialty Therapies
Acupuncture Initial Intake & Consent
TCM intake, pain patterns, and traditional acupuncture consent.
Massage Therapy Initial Intake
Health questionnaire and target areas for registered massage therapy (RMT).
Physiotherapy New Patient Form
Musculoskeletal assessment and physical rehabilitation intake.
Insurance, Billing & Privacy
Electronic Submission & Direct Billing Consent
Authorization for direct electronic billing to extended health insurers.
Benefit Assignment Form
Assignment of insurance benefits directly to Urgent Care Chiropractic Centre.
Privacy & Consent Policy
Alberta HIA compliance and patient personal health data protection statement.
Credit Card Authorization Form
Optional automated co-pay settling authorization.
Need Assistance Filling Out Forms?
If you are dealing with acute pain, a fresh car accident, or need help navigating insurance claim paperwork, our friendly front desk team is happy to assist you in person.
Call Clinic at (403) 769-9111