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Online Forms


 

White Sands Chiropractic Clinic offers our patient form(s) online so they can be completed in the convenience of your own home or 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) or bring it with you to your appointment.

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

Authorization For Chiropractic Treatment - Required

Download & Print Form

Confidential Health Profile Intake Page 1- Required

Download & Print Form

Confidential Health Profile Page 2 - Required

Download & Print Form

Missed Res and Appt Reminder Set Up - Required

Download & Print Form

Notice To Patients Financial - Required

Download & Print Form

STD HIV Disclosure - Required

Download & Print Form

Download the Free Adobe Reader®

Location
White Sands Integrative Medical
24 Beal Pkwy SW
Fort Walton Beach, FL 32548
Phone: 850-226-6728
Fax: 850-226-6729
Office Hours

Get in touch

850-226-6728