WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

PATIENT PAPERWORK

Coral Canyon 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.

  • Important: Click Here to download AdobeReader® if you don't already have it. Your internet browser will not have all the tools necessary to fill out the forms.
  • The forms are interactive/fillable: place your cursor on each line and complete each question.
  • Adobe's tools along the top of the document (ie. drawing tool) can be used to mark the body diagram.
  • You are welcome to use a digital signature or print it out to sign.
  • Fax (435-635-7701) or email (getbetter@coralchiro.com) your completed copies, but also bring the forms with you to your appointment.

Patient Information Form  This form is for the standard demographic and insurance information.


Patient Complaint Form  Tells the doctor where you are hurting and what you want accomplished with your care.


Patient History Form  Summarizes past conditions, traumas, surgeries, & medications.


Functional Rating Index  A standardized form that objectifies your complaints in the form of a quick survey.


Informed Consent  Explains the other accepted forms of treatment for musculoskeletal pain and outlines the minimal risks inherent to any medical procedure.

Click here to open, fill out, & print your paperwork


Download the Free AdobeReader®

New patients that reference our website receive a FREE tube of Biofreeze to aid in your fast road to pain relief.

Sign up using the form or call (435) 635-7771 to claim your FREE offer.

THIS ---->https://coralchirocom.chiromatrixbase.com/online-forms.html

Office Hours

DayMorningAfternoon
Monday9-121:30-6
Tuesday8-121:30-4:30
Wednesday9-121:30-6
Thursday8-121:30-4:30
Friday9-122 - 6
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9-12 8-12 9-12 8-12 9-12 Closed Closed
1:30-6 1:30-4:30 1:30-6 1:30-4:30 2 - 6 Closed Closed

Testimonial

So excited to have had my first of many treatments today by Mr. Carr & his staff. He is after all the only Chiropractor I trust. Such great people to be around. To take the time out for me the other day to explain all the imaging I brought into you shows You all go Above and Beyond. #TheyReallyDoCare

Christine B.
Hurricane, UT

Newsletter Sign Up