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.
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Adult New Patient Intake Form
(Adults and Children Age 8+) 
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Pediatric New Patient Intake Form
(Babies and Children to Age 8)
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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.
Fill out this consent form if you intend to have your minor child examined or treated without you present.
| Minor Consent Form |
Personal or Work Injury Forms
Complete the appropriate Intake Form above and appropriate forms below for Motor Vehicle Accident Injuries, Work Injuries or other Personal Injuries.
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Motor Vehicle Accident Details Form
Please complete form to provide us with details about your accident.
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Accident Claim Information Form
Please complete form to provide details about your claim
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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.
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 |
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.
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 |
In order to view the above files please download Adobe Acrobat Reader or equivalent PDF Reader.
