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Health History

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them. Contact our Southside Edmonton chiropractic office now to schedule an appointment with Dr. Daniel Bateman.

Welcome Form and Confidential Case History Form

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?

pdf icon Download & Print – Welcome Form

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Download & Print – Confidential Case History Form

Informed Consent

Before care can begin in our office, you will need to indicate that you understand some of the few risks associated with chiropractic care.

pdf icon Download & Print Form – Informed Consent Form

Direct Billing Information

Filling out the following information regarding your insurance coverage will allow us to better assist you with your care while attending our clinic.

pdf icon Download & Print Form

Free AdobeReader®

Get adobe readerEach form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Online Paperwork | Century Park Pain and Health Clinic (780) 628-7219