Patient Forms

Save some time in the office! Below you will find some of the most common forms that you can download and complete prior to arriving in the office. Please note: You may be required to present your insurance card upon arrival so please plan on bringing your card with you.


Existing Patient Forms

Patient Update Form – Has it been at least 4 months since your last visit to our office, or is it your first visit of the new year? If so, this form is for you!

NEW!! Triage Form – All patients (new and existing) are required to complete this triage form ONCE. Any items you choose not to answer must include the words “DECLINE” written next to the item.


New Patient Forms

If you are new to Sitzmann Chiropractic, we ask that you complete all of the paperwork in this section, starting with our intake form

New Patient Intake Form

Informed Consent

NEW!! Triage Form – All patients (new and existing) are required to complete this triage form ONCE. Any items you choose not to answer must include the words “DECLINE” written next to the item.

Health Evaluation Form
Medicare ABN Notice – This form is for Medicare patients only. If you have questions about the Medicare ABN policy please ask our receptionist.


Additional Forms:

Release of Medical Records – Use this form if we are going to receive a copy of your medical records from your current healthcare provider

Release of X-Rays – Use this form if you need your X-Rays released to you

Motor Vehical Accident Survey – In the unfortunate event that you have been in a car accident, there will be additional paperwork needed. Please complete all information as thoroughly and accurately as possible. DO NOT LEAVE ANY INFORMATION BLANK.

Automobile Accident Questionaire – You will need to provide a copy of the accident report upon arrival. If you have the original we will make a copy and you will keep the original.

When faxing forms please use a cover letter and fax to: 864-458-8848 ATTN: Reception

When emailing forms please provide a contact number in case we need to reach you. Emails should be sent to: sitzchiro@bellsouth.net ATTN: Reception