Tanaka and Associates Chiropractic and Massage offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us (808-356-0337) your printed and completed form(s) or bring it with you to your appointment.
General New Patient Intake Form
If you are coming to the office as a new patient please fill out the following intake form and bring it with you to your appointment:
Work Related Injury Intake Form
If you are coming to this clinic as a new patient for a work related injury, please fill out the following two forms:
Auto Accident Related Injury Intake Form
If you are coming to this office for an auto accident related injury that occured within the last 2 years, please fill out the following two forms:
Additionally, please bring your auto insurance card, claim number, and insurance contact information with you to your appointment.
Kaiser Health Insurance Members / Kaiser Senior Advantage Members /American Specialty Health Networks (ASHN) Intake Form
If you are coming to this office for the first time, and you have either Kaiser Health Insurance or if you have American Specialty Health Networks (ASHN) insurance coverage, please fill out this form. No additional intake forms are needed.
Download & Print American Specialty Networks Intake Form (ASHN/ Kaiser Health Insurance)