New Patient Forms

We would like to thank you for choosing DeFalco Family Chiropractic in Auburn, MA to help you reach your health care goals. Whether it is to get over a temporary health challenge or to improve and maintain your health and wellness, it will be our pleasure to have you visit our family chiropractic office for consultation and chiropractic treatment.  Dr. Francis DeFalco has built a successful chiropractic wellness center due to his commitment to patient health and the care that he places in his chiropractic treatment.

We encourage you to open and print the general new patient paperwork prior to entering our chiropractic wellness center.  There may be additional forms to fill out when you get to our chiropractic office depending on your insurance carrier.

Forms necessary for all new patients are the Patient Intake Form, Informed Consent to Chiropractic Treatment, HIPAA Disclosure Form and the Financial Agreement.  Having these new patient forms filled out when you enter the chiropractic office will expedite the intake process.  Please click on the appropriate links below to fill out the chiropractic forms necessary for all new patients:

Patient Intake Form DFC

Informed Consent to Chiropractic Treatment Form DFC

HIPAA Disclosure Form DFC

Financial Agreement DFC

Quadruple VAS DFC

If you were involved in a motor vehicle accident, please also fill out the new patient form below.  By filling out this form, you are giving us a description of the accident and providing important information to the chiropractic doctor.

Automobile Accident Injury Form DFCPatient Intake Form DFC

Thank you again for choosing DeFalco Family Chiropractic in Auburn, Massachusetts for your chiropractic treatment, chiropractic care and total wellness.  We not only wish you to live a long life, but a long, healthy and happy life that is free of pain.  Chiropractic care may be what your body needs.

Dr. Francis DeFalco and all of the staff here at DeFalco Family Chiropractic want your visit to our chiropractic office to be as pleasant and comfortable as possible.  If you have any questions at all about these chiropractic forms for new patients, please contact our family chiropractic office.  We are happy to answer all of the questions that you have about chiropractic care as it relates to your health condition.

Dr. Francis DeFalco takes a holistic approach to chiropractic treatment so that your chiropractic care is specific to your body’s needs.  Every chiropractic decision made by the chiropractic doctor is personalized and customized so you see the best results.  All of us here at DeFalco Family Chiropractic are dedicated to seeing that your journey to overall health and wellness starts today, with the right chiropractic care.