illinois chiropractic society

Forms and templates library

Editable forms and templates for your practice.

Do You Need that Perfect Form for Your Practice?

The following forms are researched, flexible, accurate, and easily tailored to your practice needs. ICS members in good standing can download, edit, and continue to utilize these forms and templates for FREE in their offices throughout their membership lives (please see licensing terms and conditions below). Downloading is an easy one-step process – When you select to download a form below, we will take you to your account and automatically download the form.

Click on the form name or the + to expand the category listing. Once expanded, you will find a link to the various forms and templates along with a link to an article that explains how to use the linked form. Jump to your needed category by clicking a category button here:

Consent

Financial

HIPAA

Human Resources

Insurance

Other

Patient Resources

Scope

Insurance

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PATIENTS’ RIGHT TO DIRECT PROVIDER NOT TO SUBMIT A CLAIM TO HEALTH PLAN
NON-DISCRIMINATION APPEAL LETTER
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AUTHORIZED RELATIVE CERTIFICATION

Financial

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FINANCIAL HARDSHIP WAIVERS
SUBPOENAS TO TESTIFY
NON-DISCRIMINATION APPEAL LETTER
CALCULATING PROFITABILITY FOR PRACTICE SUCCESS

Scope

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ADVERTISING “PHYSICAL THERAPY”
MODIFYING STUDENT PHYSICAL EDUCATION

Patient Resources

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AN OPIOID EPIDEMIC TOOLBOX
DRUGS OR CHIROPRACTIC CARE FOR LOW BACK PAIN?

HIPAA

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Human Resources

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EMPLOYEE CONCEALED CARRY

The Illinois Chiropractic Society (ICS) grants exclusively to ICS members in good standing (“authorized users”) a non-transferable license to use ICS Forms and Templates above for the purposes set out in the full terms and conditions. Your use of our site and its Forms and Templates constitute your agreement to abide by the Terms of Use and License of ICS Forms and Templates.

As a reminder, this License terminates for any Illinois Chiropractic Society member user at such time as the member is no longer in good standing according to the ICS bylaws. Users who are not in good standing, including without limitation those who are not current in payment of dues, are not authorized to use ICS forms and Templates, and any such use is strictly prohibited.