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Online Forms

Cosh Chiropractic Care & Wellness Center offers our patient form(s) online so you can complete it in the convenience of your own home or office.  There are two options for New Patient paperwork submission.


 ***  STEP ONE:  The quickest method of Intake Form Submission is to select the following link and complete all pertinent and appropriate boxes. Your information will be immediately and securely sent to our office. Please be advised that some information may be requested from you upon arrival. 

**** ONLINE INTAKE FORM SUBMISSION

https://www.mychirotouch.com//patientintake/?clientid=CCCA0003

OR

Generate a printable version of your Patient Intake form for those patients who prefer not to fill out their form via the web or iPad.

Print & Complete BASIC PATIENT INTAKE FORM 
/storage/app/media/CTIntake_Insurance_COSHCHIRO.pdf

***STEP TWO:

You may choose to print & complete  OR  review and complete upon arrival, the additional required documents:

Print & Complete Required Office Forms (LEGAL FORMS):

/storage/app/media/REQUIRED_FORMS_COSHCHIRO.pdf

***PERSONAL INJURY ONLY:

Supplemental Intake Form (Personal Injury) 



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Location

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Office Hours

Our Regular Schedule

Monday:

9:00 am-12:00 pm

2:30 pm-5:00 pm

Tuesday:

9:00 am-12:00 pm

2:30 pm-5:00 pm

Wednesday:

9:00 am-12:00 pm

2:30 pm-5:00 pm

Thursday:

9:00 am-12:00 pm

2:30 pm-5:00 pm

Friday:

9:00 am-12:00 pm

2:30 pm-5:00 pm

Saturday:

Closed

Sunday:

Closed