Your Health History
We offer our paperwork on line so you can complete it in the convenience of your own home.
New Patient Forms
Please compete the following forms if you are a new patient to our office. You can download these forms and fill them out.
- Confidential Patient History
- Assignment of Benefits
- Notice of Privacy Practices for Shippy Chiropractic - This is a read only document
- Acknowledgement of Receipt of Notice of Privacy Practices
Once they are completed you can:
- Print them and bring them with you on your first visit. OR
- Email them back to our office at nedwards@shippychiropractic.com OR
- Fax them to (972) 769-9504
Accident Forms
If you are visiting our office for an auto or work accident please complete the following form in addition to the ones above:
How Can We Help?
I am looking forward to meeting you in person and discussing how we can help you get on the road to wellness. Give us a call today to schedule your appointment.
CONTACT US