Broussard Clinic of Chiropractic & Acupuncture

A Conservative Approach To Health Care
Home
News
Chiropractic
Posture
Nutrition
Acupuncture
Back Pain
Mind - Body Connections
Exercises
Blog
Newsletter
Spine Classes
Testimonium
New Patient Forms
About Dr. Broussard
Contact Us
Links
New Patient Forms & Questionnaires
 
Dear Prospective New Patient,
 
Thank you for coming to our website to prepare for your initial office visit.  Please find below, several categories of patients, and their unique forms to complete prior to seeing the doctor.
 
We ask that ALL new patients complete the initial "Health History Questionnaire". 
 
Then, browse through the other categories, and complete and sign the appropriate forms.
 
If you have any questions, please call us at 806-796-0098.
 
INTAKE FORMS
All New Patients:
 
If you have Regular Medical Insurance:
 
If you have Medicare:
 
Acupuncture Patients:
 
Chiropractic Patients:
 
 
SYMPTOMS FORMS
If you are having any symptoms, please fill out the first form, the QVAS, and then choose from the selected body parts below and complete the appropriate forms.  Thank you!
 
Back Pain (Revised Oswestry)
Ankle Grading System Form (some to be completed by physician)