Hatfield Chiropractic & Rehab Center
(361) 358-2578
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New patients are always welcome at Hatfield Chiropractic!  

New Patient Forms must be completed to ensure you will receive the best care possible.   
The following forms are provided for your convenience.  By completing these forms ahead of 
time, you will save time during your initial visit.   

If you have trouble understanding any part of the forms, we will gladly answer any questions 
when you come in.   

These forms are available in PDF format.  To download them, you will need the free 
Adobe Acrobat Reader.  If you do not have it, download it here.

    Patient Intake Form

    Case History Form

    Informed Consent Form

If you have been involved in an accident, also complete the following form:

   Personal Injury Form

Bring the completed forms and your identification card with you to your first visit.

We appreciate the opportunity to serve you and your family.

     This is for your information only:

         HIPAA Notice of Privacy Practices 
         This Privacy Notice is being provided to you as a requirement by Federal Law--The Health Insurance 
           Portability and Accountability Act (HIPAA)--efffective April 14, 2003.

New Patient Forms