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Online Forms

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Intake chiropractic patient forms are available on this page to help make check-in faster and easier.

Fill out what you can and we will help you with any questions at your appointment. If you need assistance while at home call the DC Chiropractic Center at 503-585-2585 and one of our support staff will help you.


Injured in an Auto Accident

 Intake Form

 Doctor Lien

 HIPAA

 Consent Form

 Assignment of Insurance


Injured At Work

 Intake Form

 Doctor Lien

 HIPAA

 Consent Form

 Assignment of Insurance


Health Insurance

 Intake Form

 Cash Policy

 HIPAA

 Consent Form

 Assignment of Insurance


Oregon Health Plan (OHP)

 Intake Form

 Doctor Lien

 HIPAA

 Consent Form

 OHP Policy


Medicare

 Intake Form

 Cash Policy

 HIPAA

 Consent Form

 Medicare Policy


No Insurance

 Intake Form

 Doctor Lien

 HIPAA

 Consent Form

 Cash Policy

DC Chiropractic Center

Address

1765 State St Ste A,
Salem, OR 97301

Monday  

9:00 am - 6:00 pm

Tuesday  

9:00 am - 4:00 pm

Wednesday  

9:00 am - 6:00 pm

Thursday  

9:00 am - 4:00 pm

Friday  

9:00 am - 6:00 pm

Saturday  

Closed

Sunday  

Closed