If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

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

Close [x]

Borges 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.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) at 530-544-5802 or bring it with you to your appointment.

PatientAlly

In our office you have a choice in filling out the Application for Treatment forms, by paper at the office, down load these forms here; then FAX or bring them to the office, or use the convenient online process using PatientAllly.com that you can access on this web site.

If you choose online, it takes about 2 minutes to set up the free Electronic Health Records account and about 30 minutes to fill out all the Health forms. For further details see the PatientAlly tab or click PatientAlly.com and go directly to PatientAlly.



New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Additional Forms

Download & Print Form Neck Index
Download & Print Form  Lower Back Index
Download & Print Form  Patient Record Disclosure


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form


Download the Free AdobeReader®