If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site


You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

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.  There are two options for New Patient paperwork submission.

***  FIRST Option:  select the following link and complete all pertinent and appropriate boxes.  Your information will be immediately and securely sent to our office.      


**AUTHORIZATIONS:  Many of the insurance plans accepted by our office require our patients to complete forms to ensure medical necessity. If you are not sure if you are required to request prior authorization, please complete these forms for you initial visit. For your convenience these forms are available to print and complete from home. Please download the appropriate form for your visit type as well as the condition that you would like to be seen for. If you are unable to print these forms they will be provided for completion at your appointment. 

Required Authorization Request Forms - Initial Visit for a New Injury or New Condition

Required Authorization Request Forms - Follow Up for Continued Care or Release of Care

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form

Download the Free AdobeReader®