Cosh Chiropractic Care & Wellness Center offers our patient form(s) online so you can complete it in the convenience of your own home or office. Please completing the required Intake form(s) and click SUBMIT (please DO NOT PRINT and bring to our office):
Please complete the intake for in its entirety without interruption or the data will not save and you will have to start at the beginning.
The quickest method to submit the Patient Intake Form is to select the following link and complete all pertinent and appropriate boxes. Complete the questionnaire as thoroughly as possible to ensure the proper form(s) populate to your chart. Your information will be immediately and securely sent to our office. Please be advised that some information may be requested from you upon arrival.
(please click the following link to be directed to the online version of the Patient Intake Form)
Note: If patient is requesting treatment for a Personal Injury or a Work Related Injury the claim number and date of injury is required.