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541.757.9933 H
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541.757.9933

Online Forms

Heresco Chiropractic & Associates offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

*New Patient* Health History & Welcome Form

Welcome to Heresco Chiropractic. Please print and fill out if you are New Patient to our clinic. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & print this form for your New Patient Visit! /clients/2489/documents/Online New Patient Forms 06.2017.pdf

*Established Patient* History Update

Welcome back to Heresco Chiroparctic. Please print and fill out this form if has been more than 6 months since your last visit to the clinic. 

Download & print this form for your appointment if it has been more than 6 months since your last visit! /clients/2489/documents/Online_Forms_Patient_History_Update_2017.pdf

Additional Informed Consent, HIPPA and Financial Policy Forms

These are forms are required to be signed prior to treatment with one of the doctors at Heresco Chiropractic

Download & print these forms for any New, Established, Motor Vehicle and Work Injury appointment.

Informed Consent: /clients/2489/documents/Online_Forms_Inforrmed_Consent.pdf

HIPPA Forms: /clients/2489/documents/Online_Forms_HIPPA_Consent_Form.pdf

Financial Policy: /clients/2489/documents/Online_Forms_Financial_Policy.pdf

Motor Vehicle Accident Forms

If you have scheduled an appointment because you were in a car accident, please print and fill out this form. 

Download and print this form if you have recently been in a Motor Vehicle Accident! /clients/2489/documents/Online Forms_Motor Vehicle Accident Paper Work 2017.pdf

Work Injury Forms

If you have scheduled an appointment because you were involved in a work injury, please print and fill out this form. 

Download and print this form if you have recently been in a Work Injury! /clients/2489/documents/Online_Forms_Work_Injury_and_Lien_2017.pdf

Scoliosis Screening Forms

If you have scheduled an appointment because you are having a scoliosis screening, please print and fill out this form. 

Download and print this form if you are having a Scoliosis Screening! /clients/2489/documents/Scoliosis_Screening_Contact_Information_and_Consent_2017.pdf


Member Wellness Registration Form - Optional

You can sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can Click Here to register online!We look forward to making your experience with our office and website more interactive and rewarding!



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Sport Physicals

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Office Hours

Day
Monday8:00 am6:30 pm
Tuesday8:00 am6:30 pm
Wednesday8:00 am6:30 pm
Thursday8:00 am6:30 pm
Friday8:00 am6:15 pm
Saturday9:00 am4:30 pm (After 4:30 - Physician On Call)
SundayPhysician On Call
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00 am 8:00 am 8:00 am 8:00 am 8:00 am 9:00 am Physician On Call
6:30 pm 6:30 pm 6:30 pm 6:30 pm 6:15 pm 4:30 pm (After 4:30 - Physician On Call)

Sport Physicals

NEWS:

Appointments are now being scheduled
for school sports physicals

541.757.9933

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Corvallis Chamber member

541.757.9933

Call Us Today!