Patient Forms

New Patient Forms


Thomas J. Van Hee, DC, PC offers our patient forms online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary forms from the list below that pertain to your visit, print them out and fill in the required information.
  • Bring them with you on your first appointment.

New Patient Intake Form

Completion of this form helps us to understand your health history and the current state of your health. What questions, concerns or goals regarding your health and wellness can we help you with? Let us know — we're here to help you!­

Patient Intake and History
Download and Print Form
Patient Symptoms
Download and Print Form
Informed Consent Sept17
Download and Print Form
HIPAA Nov2016
Download and Print Form

Call (541) 386-3988 or click to schedule your appointment.