Back in Line Chiropractic Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Our forms may be completed on your computer and then printed, or the blank forms may be printed and filled out by hand.
• Compete the necessary forms with all information requested and print them.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Forms - Required

These forms will help us to know the history and current state of your health.  If you have questions or concerns about your wellness, please let us know.  We would also welcome the opportunity to help you set and reach your goals.

• Patient Medical History
• Chiropractic Registration and History
• Informed Consent
• Notice of Privacy Practices
• Receipt of Notice of Privacy Practices
• Patient Consent for  Use and Disclosure of Protected Health Information
• Standard Disclosure and Acknowlegement

  Patients Involved in Accidents

These forms are necessary to assist us in your individualized treatment and recovery.

• Assignment of Benefits
• Authorization to Obtain PIP
• Automobile Accident Form
• Letter of Protection
• Patient Disclosure and Acknowledgement
• Standard Disclosure and Acknowledgement

Please feel free to browse Our website for more information about Back In Line Chiropractic Center in Plantation, Florida. If you have any questions or would like to schedule an appointment we can be reached by calling 954-584-BACK (2225) or use our contact form.