The Back Alley Chiropractic & Massage offers our patient forms online so you can print and complete in the convenience of your own home or office. Contact our office at (520) 877-2666 with any questions about which forms you should download.
1) If necessary, install AdobeReader® to your computer, click here to download. 2) Download the applicable forms, print, fill in the required information in full, and sign each page. 3) Bring the completed forms with you to your appointment or fax them to us at (520) 877-9183.
Patient Insured or Selfpay (non-medicare)
Medicare Part B Patient
Auto Accident/Personal Injury Patient
Also complete each of the applicable forms:
Work Comp Patient
Also complete each of the applicable forms:
HIPAA Forms
General Forms
PiezoWave2 MyACT
Massage Therapy
Insurance Specific
Complete the applicable form(s) for your plan only if directed to:
UnitedHealthcare AARP Medicare Advantage plans
BCBS Arizona, Cigna, Ambetter plans
Humana Choice Care Network plans
*If you have completed a Worker’s Report Of Injury form with your Employer please bring a copy with you to your appointment, otherwise complete this form in full.