• Home
  • Services
  • About Us
  • Contact Us
  • New Patient
    • What to Expect
    • Patient Forms
    • Virtual Office Tour
  • Reviews
  • Blog
  • Privacy Policy
  • Health Resources
JayMac Chiropractic
  • Home
  • Services
  • About Us
  • Contact Us
  • New Patient
    • What to Expect
    • Patient Forms
    • Virtual Office Tour
  • Reviews
  • Blog
  • Privacy Policy
  • Health Resources

New Patient Intake Forms​

Intake forms like the ones below are used by the doctors at JayMac Chiropractic to accurately diagnose your condition or chief complaint and then develop effective treatment plans. Please print these forms out and complete in the comfort of your home or office. 
Adult New Patient Intake Form 
(Adults and Children Age 8+)
Adult New Patient Intake Form
File Size: 702 kb
File Type: pdf
Download File

Pediatric New Patient Intake Form
(Babies and Children to Age 8)
Pediatric New Patient Intake Form
File Size: 745 kb
File Type: pdf
Download File


Minor Consent Form (18 and under) 
​Fill out this consent form if you intend to have your minor child examined or treated without you present.
Minor Consent Form
File Size: 654 kb
File Type: pdf
Download File


Arizona Worker's Compensation Form
Please complete the top portion of this form if you were injured while working and have an open Worker's Comp claim with your employer. 
AZ Workers Comp Form ICA 0102
File Size: 539 kb
File Type: pdf
Download File


Motor Vehicle Accident Details Form
Please complete form to provide us with details about your accident. 
Motor Vehicle Accident Details
File Size: 590 kb
File Type: pdf
Download File


Medical Records Release Form
Please complete this form if you were treated by another doctor and would like your records sent to us for review. 
Medical Records Release Form
File Size: 481 kb
File Type: pdf
Download File


In order to view the above files please download Adobe Acrobat Reader or equivalent PDF Reader. 
Picture

ADDRESS

​22711 S. Ellsworth Rd
Suite # G106
​Queen Creek, AZ 85142

OFFICE HOURS

Monday, Wednesday
8am-12pm, 1pm-5pm
Tuesday, Thursday
10am-12pm, 1pm-7pm
Friday
8am-12pm
​Satrday/Sunday
Closed

Click here for accurate holiday and modified hours.  

CONTACT INFO

Picture
Email
Info@JayMacChiropractic.com




© 2020 JKM LLC dba JayMac Chiropractic | Best Chiropractor in Queen Creek and San Tan Valley | JayMac Chiropractic
  • Home
  • Services
  • About Us
  • Contact Us
  • New Patient
    • What to Expect
    • Patient Forms
    • Virtual Office Tour
  • Reviews
  • Blog
  • Privacy Policy
  • Health Resources