Our New Patient Forms

It will speed up the process of your first visit with us if you print and fill out a new patient form before your appointment. Please bring the filled out form(s) to your first appointment and if you have any questions about the forms feel free to give us a call at 320-253-5650. We value your time and want all appointments to go as smooth as possible.

If you are printing out forms for a minor, please have the parent or gaurdian fill out the "Informed Consent" form.

Patient Forms — St. Cloud, MN — Minser Chiropractic Clinic

Personal Health Information

Massage History/Treatment Information

Previous History (include year and treatment received)

Health History

Musculo-Skeletal

It is my choice to receive massage therapy. I realize that the treatment is being given for my well being of mind and body. This includes stress reduction, relief from muscular tension, spasm or pain, or for increasing circulation. I agree to communicate with my practitioner any time I feel my well being is being compromised.


I understand that massage practitioners do not diagnose illness, disease or any physical or mental disorder. Nor do they prescribe medical treatment, pharmaceuticals or perform spinal manipulation. I acknowledge that massage therapy is not a substitute for medical examination or diagnosis.


I have stated all medical conditions that I am aware of and will update the massage practitioner of any changes in my health status.


*Please inform the office if you cannot make a massage appointment at least 24 hours before your scheduled appointment.

Insurance Information

Minser Chiropractic Clinic accepts most insurances including: Workers Compensation, BCBS, Personal Injury/Auto, Medicare, Preferred One, Medica, UCare, Health Partners, Blue Plus, and many more. If you need more information about your insurance coverage, call our office manager at 320-253-5650. As a courtesy to our patients, we do the insurance billing.

We thank you for choosing us to provide quality chiropractic care for you and your family. We also thank you for your referrals. Without you, we could not help others.

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