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Patient Evaluation Forms

Dr. Schramm and our friendly chiropractic staff in Murray, Utah, look forward to meeting you in person. Before your first appointment, please download, review and sign each of the forms below, and then bring them into the clinic. These forms ensure that you understand how our practice works, your responsibilities for payment, and what we do with your medical information. Forms below also cover legal matters relating to auto insurance settlements and payments. If you are unable to download and sign the forms or if you have questions, please arrive early for your appointment. You may also call us at 801-747-2886 with questions or concerns.

We will also need a copy of your health insurance information, any relevant auto insurance information and a photo ID for your first appointment. Also, please bring any X-rays or health documents that would assist us in creating your custom treatment plan.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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Our Locations

Office Hours

Utah Injury Clinic


9:00 AM-11:00 AM

2:00 PM-4:30 pm


9:00 AM-12:00 pm


9:00 AM-11:00 AM

2:00 PM-6:00 pm


9:00 AM-11:00 AM

2:00 PM-6:00 pm


9:00 AM-11:00 AM


On Call


On Call