A chiropractic examination form is like any other examination form that requires some basic details about the examinee’s background. A chiropractor ought to have science background and faith in the body’s own process of healing.
You can Download the Chiropractic Examination Form Template, customize it according to your needs, and Print it. Chiropractic Examination Form Template is either in MS Word or Editable PDF.
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Features:
Personal Information:
Name: Collects the patient’s full name.
Address: Records the patient’s residential address.
Email ID: Collects the patient’s email address.
Gender: Asks for the patient’s gender.
Date of Birth: Records the patient’s date of birth.
Contact Number: Collects the patient’s phone number.
Last Institution Attended: Asks for the name of the last educational institution attended.
Educational Qualifications:
School Name: Collects the names of schools attended.
Overall Percentage Acquired: Records the percentage obtained in each level of education.
Exam Year: Specifies the year of the examination.
College Attended:
Name of College: Collects the name of the college attended.
Year of Graduation: Records the year of graduation.
Percentage Acquired: Records the percentage obtained in the college degree.
Examination Center Preference:
Examination Center Choices: Allows the patient to specify two preferred examination centers with their respective codes.
Declaration:
Signature: Requires the patient’s signature to confirm the accuracy of the information provided.
Date: Records the date of signing the form.
Benefits
Standardization:
Ensures consistency in collecting patient information.
Clarity: Clearly outlines the required information, making it easy for patients to fill out the form.
Efficiency:
Streamlines the patient registration process.
Record Keeping:
Serves as a valuable record of patient information, which can be important for future reference and also treatment planning.
Data Analysis:
Can be used to analyze patient demographics and also identify trends.
Compliance:
Helps chiropractic clinics comply with relevant regulations and also standards.
