Access to all of these convenient forms in one place.
Chiropractic doctors are primary care, “portal of entry” doctors and often do not require referrals. YOUR INSURANCE PLAN (particularly HMO plans), when medical necessity is met, may offer insurance coverage based on the terms of your insurance plan– but MAY require a referral prior to reimbursement. Chiropractic care referrals or preauthorization is never required for self-pay.
Physical Therapists in Virginia may be often see patients without a referral for up to 30 days when medical necessity is met.
Some insurance companies, personal injury and workers compensation companies may cover therapeutic massage when medical necessity is met! Ask your insurance company or appropriate claim adjuster or supervisor for details
Feel free to contact your insurance plan or our office regarding any questions.
Choose from ‘complete’ (all forms pages 1-5 in one) or in sections
| FORM | DWN | Scan individual QR’s |
| Complete 1-5 The downloadable .pdf from can be completed as a fill in, then saved, printed or emailed to our office | Use individual QR’s | |
| Registration and Chief Complaints (Concerns) 1-2 |    | |
| Family History 3 |    | |
| Review of Systems 4-5 |   |
| FORM | DWN | Scan individual QR’s |
| Personal Injury Complete 1-5 |  | |
| Workers Compensation Reminder: In Virginia, Workers Compensation requires an authorization from your immediate supervisor or case manager prior to receiving care. |   | |
| FORM | DWN | Scan individual QR’s |
| Update Form When a new injury or flare up (exacerbation) occurs, please complete this form prior to seeing the doctor on your next visit. |   | |
| SF-20 |   | |
| SF-36 |   | |
| Anatomy Handout | JPG |  |
Additional Forms
“Health is Wealth“
once said by a very wise person
myharbourhealthcare.com 
