For your convenience, Three Kings Chiropractic offers the forms required at the begining of treatment online. You simply need to download the files, print them out, fill them out, and either fax them to our office or bring them with you to your appointment. Of course, you always have the option of filling them out in the office, but it is faster both for you and for Dr. Roland for them to already be completed.

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Patient Demographics Form

Click here to download and print this form.

Insurance Verification Form

Click here to download and print this form.

Patient Consent Form 

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Payment Policy

Click here to download and print this form.

Health Care Information Authorization Form

Click here to download and print this form.

List of Patient Doctors

Click  to here download and print this form.

List of Medications, Surgeries and Illnesses 

Click here to download and print this form.

Symptom Survey

Click here to download and print this form.

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