Phone: (425) 746-0420 / Fax: (425) 746-1587
Gober Chiropractic Center
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New Patient Forms

We are happy you have decided to come see us for care!  If you are NOT seeing us for an auto accident or work injury claim, please have the following documents completed for your first visit:
Treatment_Application_2023.pdf
File Size: 832 kb
File Type: pdf
Download File

Past_Medical_History_2023.pdf
File Size: 116 kb
File Type: pdf
Download File

Term_of_Acceptance_2023.pdf
File Size: 584 kb
File Type: pdf
Download File

Auto Accident Forms

If you have been involved in an auto accident, please complete the following documents.  
Auto_Accident_History_2023.pdf
File Size: 176 kb
File Type: pdf
Download File

Treatment_Application_2023.pdf
File Size: 832 kb
File Type: pdf
Download File

Past_Medical_History_2023.pdf
File Size: 116 kb
File Type: pdf
Download File

Auto_Accident_Information_2023.pdf
File Size: 199 kb
File Type: pdf
Download File

Term_of_Acceptance_2023.pdf
File Size: 584 kb
File Type: pdf
Download File

Work Injury Forms

If you have been hurt on the job, the main form you will need to complete cannot be uploaded to the website so you will need to fill that out before your first visit.  However, these are the other forms you will need for your first visit:
Treatment_Application_2023.pdf
File Size: 832 kb
File Type: pdf
Download File

Past_Medical_History_2023.pdf
File Size: 116 kb
File Type: pdf
Download File

Term_of_Acceptance_2023.pdf
File Size: 584 kb
File Type: pdf
Download File

For Teens and Kids!

Yes, we care for children and teenagers too!  For teens and children ages six and older, please complete all of the forms listed under "New Patient Forms" except the "Past Medical History" (unless your teen has a significant medical history that we should know about).  For children under the age of five, please complete the following forms:
Pediatric_History_2023.pdf
File Size: 191 kb
File Type: pdf
Download File

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