WORD Version (Fill out in WORD, Print, and Bring with you)

If you have Microsoft WORD then you can follow these steps: 

 

 

1. Download the form(s) needed. Only do the first questionnaire (case history) unless asked to do the others!

 

2. Open them in Microsoft WORD

 

3. Fill out the forms in WORD

 

4. Print them

 

5. Bring them with you

CASE HISTORY - (Fill out in WORD - Print - and Bring with you)
!CASE HISTORY Electronic Fill Then Print[...]
Microsoft Word document [84.0 KB]
HARPER HEALTH INDICATOR TEST - (Fill out in WORD - Print - and Bring with you)
!Harper Health Indicator Test - Electron[...]
Microsoft Word document [41.3 KB]
SYMPTOM SURVEY FORM - (Fill out in WORD - Print - and Bring with you)
!SYMPTOM SURVEY FORM (Maestro) - Electro[...]
Microsoft Word document [89.8 KB]

- - - OR - - if Microsoft WORD Is not an Option - - then - - -

PDF Version (Print, Fill out by Pen, and Bring with you)

If you DO NOT have Microsoft WORD then you can follow these steps and fill them out manually: 

 

1. Download or Open the three (3) Forms needed (PDF). Only do the first questionnaire (case history) unless asked to do the others!

 

2. Print out the Forms

 

3. Fill them out by Pen

  

4. Bring them with you

PDF Version (Print, Fill out with Pen by Hand, and Bring with you)

CASE HISTORY - If you don't have WORD - you can PRINT this - fill out in Pen and Bring with you
CASE HISTORY Electronic Fill Then Print [...]
Adobe Acrobat document [291.2 KB]
HARPER HEALTH INDICATOR TEST - If you don't have WORD - you can PRINT this - fill out in Pen and Bring with you
PRINT FIRST - Harper Health Indicator Te[...]
Adobe Acrobat document [354.9 KB]
SYMPTOM SURVEY FORM (Maestro) - If you don't have WORD - you can PRINT this - fill out in Pen and Bring with you
PRINT FIRST - SYMPTOM SURVEY FORM (Maest[...]
Adobe Acrobat document [353.5 KB]

NEXT, READ our PATIENT INFORMATION PRIVACY POLICY before your appointment. This step applies to all new patients. THEN, download, print and sign EITHER the "Agree" or "Disagree" to our privacy policy and bring to your first appointment.

Privacy Posting.doc
Microsoft Word document [101.5 KB]
I Agree.doc
Microsoft Word document [65.5 KB]
I Disagree.doc
Microsoft Word document [66.0 KB]

  Other Handouts - - Not Required for New Patients

Aids for Body Detoxifaction
Aids_BodyDetoxifaction.pdf
Adobe Acrobat document [20.6 KB]
Authorization For Records
AuthorizationForRecords.pdf
Adobe Acrobat document [14.2 KB]
Barnes Thyroid Test
BarnesThyroidTest.pdf
Adobe Acrobat document [10.4 KB]
Diet for the Diabetic
Diet_for_the_Diabetic.pdf
Adobe Acrobat document [143.8 KB]
Fiber Content of Foods
Fiber-Content-of-Foods.pdf
Adobe Acrobat document [943.5 KB]
Fiber Sources
Fiber Sources.pdf
Adobe Acrobat document [18.4 KB]
Food Diary
Food Diary.pdf
Adobe Acrobat document [10.7 KB]
Foods Placemat
FoodsPlaceMat.pdf
Adobe Acrobat document [367.2 KB]
Food Substitution Guide
Food_Substitution_Guide.pdf
Adobe Acrobat document [15.9 KB]
Grains and Beans cooking times
Grains_and_Beans_cooking_times.pdf
Adobe Acrobat document [22.1 KB]
Hidden Sources of MSG
HiddenSourcesMSG.pdf
Adobe Acrobat document [16.5 KB]
Home Enema Procedures
HomeEnemaProcedures.pdf
Adobe Acrobat document [19.2 KB]
Immunization Exemption - Conscience
ImmunizationExemptConscience.pdf
Adobe Acrobat document [16.5 KB]
Immunization Exemption - Religious
ImmunizationExemptionReligious.pdf
Adobe Acrobat document [12.8 KB]
Instructions for Hair Analysis
Instructions_HairAnalysis.pdf
Adobe Acrobat document [16.5 KB]
Iodine Skin Test
IodineSkinTest.pdf
Adobe Acrobat document [9.7 KB]
Liver and Gall Bladder Flush
LiverGallBladderFlush.pdf
Adobe Acrobat document [18.7 KB]
Lugol's Protocols
Lugol.pdf
Adobe Acrobat document [9.9 KB]
Perfect Eating
PerfectEating.pdf
Adobe Acrobat document [745.6 KB]
Shorthand Key
ShorthandKey.pdf
Adobe Acrobat document [10.0 KB]
Supplement Schedule Chart
SupplementSchedule_Chart.pdf
Adobe Acrobat document [305.3 KB]
Supplement Schedule for Surgery
SupplementSchedule_Surgery.pdf
Adobe Acrobat document [10.3 KB]
Top 10 Total Health Ideas
TOP_10_TOTAL_HEALTH_IDEAS.pdf
Adobe Acrobat document [115.3 KB]
Yeast Infection Therapy
Yeast_Infection_Therapy.pdf
Adobe Acrobat document [35.8 KB]

Available at:

Denito Chiropractic Clinic, PC

408 N Allen Dr

Allen, TX 75013 

(972) 727-8947

Practice Hours

Mon    3:30pm - 7:30pm

Tue      12:00pm - 4:00pm

Wed    8:30am - 12:30pm

Thur     12:00pm- 4:00pm

Fri         8:30am - 12:30pm

             4:00pm - 7:30pm

Sat       10:00am - 2:00pm

Sun       CLOSED

Get Social With Us

DISCLAIMER: Information, resources or tools contained within are not designed to self-diagnose or self-treat. Diagnosis and treatment of all health conditions should only be performed by your doctor of chiropractic or other licensed health care professional.

Print Print | Sitemap
© Denito Chiropractic