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New Patient Forms

Man filling out paperworkAt Higley Family Chiropractic, we offer our paperwork online so you can complete it in the convenience of your own home.

Patient Information

This lets us know what’s happened, but perhaps more important, where do you want to take your health?

Confidential Health Report

If your health issue is the result of a car accident, we need some additional information.

Terms of Acceptance

If your health issue is the effect of an injury at work, this information will help us help you.

Privacy Consent

If you have received chiropractic care elsewhere, or have medical records we will need from another practitioner, please sign this release.

Intake Forms | Chiropractor Nebraska City | (402) 713-5105