ACCEPTANCE AS PATIENT

I understand and agree that Dr. David DeFries D.C. has the right to refuse to accept me as a patient any time before treatment begins. The taking of a history and the conducting of a physical examination are not considered treatment, but are part of the process of information gathering so that the doctor can determine whether to accept me as a patient.

By clicking next, I agree with the above statement and wish to continue with providing my information.

As you go through the form, some questions will require short answers. If you are using a phone or tablet, you can click the microphone icon and speak your answers or type them using the keyboard.
Questions which allow for multiple answers (how do you describe the pain) will contain squares next to the answers while single answer questions (where does it hurt) will have circles.
Most questions will auto advance to the next after answering while others will require you to hit the arrow at the bottom of the screen. Several questions are required and you will not be able to proceed without answering them. 
There are two sections:

Intake Information: Patient information, present complaints and medical history
Practice policies and HIPPA

Most patients complete these forms in under five minutes. 
These forms must be completed prior to the appointment.

Next will be a series of symptoms. If you currently are experiencing these or have in the past, please select Yes or choose No if they do not apply.