Patient Forms

• Auto Accident Intake Form

Please click on the fillable PDF below to complete the Auto Injury Intake Form. After you complete this form, you can send this document directly to us without having to print anything. To do this:

1. Save document
2. Email attachment to:
   Crofton: eihcrofton@gmail.com
   Millersville: effectivechiropractic1@gmail.com

• CT Intake Form - Millersville
• CT Intake Form - Crofton

• Pediatric Form (under 8 years old)
• CT Intake Form (8-17 years old) - Millersville
• CT Intake Form (8-17 years old) - Crofton

• Patient Update Form