Exam form - chiropractic - ChiroAssistantscom 2026

1. Click ‘Get Form’ to open the Exam form in the editor.
2. Begin by entering the PROVIDER/CLINIC NAME and DATE OF VISIT at the top of the form.
3. Fill in the PATIENT's name and date of birth, then check all applicable boxes for patient status: NEW PATIENT, RE-EVALUATION, NEW CONDITION, or ROUTINE VISIT.
4. For initial exams or new conditions, provide the first date symptoms were noticed and describe the major complaint in the designated fields.
5. Utilize the subjective pain assessment section by marking areas of pain on the diagrams provided and indicating pain types using letters (A, B, ST, etc.).
6. Circle a number on the pain scale that best describes overall pain from 0 (none) to 10+ (excruciating).
7. Complete additional sections such as RANGE OF MOTION ASSESSMENT and MUSCLE TESTS by filling in relevant data as instructed.
8. Finally, ensure both patient/legal guardian and doctor/provider signatures are completed at the end of the form.

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