Brian M. Murray, D.C.                        Michele L. Murray, D.C.
     Chiropractic Physician                                            Chiropractic Physician

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New Patient Office Forms

Paperwork can be filled out prior to your scheduled office visit and either faxed to (614) 771-6632 or can be printed and accompany you on your first visit.
New Patient Forms


New Patient Intake Form 2

New Patient Pain Diagram

HIPAA Notice of Privacy Practices

HIPAA Acknowledgement of Receipt


United Healthcare (ACN/Optum Health) Specialty Forms
*Not required for ALL United policies - Please verify with office manager if your plan requires this additional paperwork. 

Patient Progress Questionnaire

Low Back Index

Neck Index


Motor Vehicle Accident and Personal Injury Forms

Vehicle Accident Information Form 1

Vehicle Accident Information Form 2

Personal Injury Insurance Information

Industrial/Work Injury Questionnaire


ASHN/Cigna Specialty Forms
*Not required unless patient exceeds 5 visits per calender year
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