Chiropractic Adjustment Table Damage Claim Form

When chiropractic adjustment tables malfunction or sustain damage—especially during patient care—proper documentation is critical for insurance claims, equipment warranty processing, and professional liability protection. This Chiropractic Adjustment Table Damage Claim Form provides a structured, professional way for chiropractic practices to capture every detail needed for a complete damage report.

Designed specifically for chiropractic clinics, this template covers patient incident information, equipment specifications, maintenance history, and malpractice insurance notification workflows. Whether you're filing a warranty claim with your equipment supplier, notifying your professional liability carrier, or creating an internal incident record, this form ensures nothing falls through the cracks.

Built for chiropractic practices that need to:

• Document equipment damage incidents quickly and thoroughly during or after patient appointments
• Capture patient safety details and witness statements when incidents involve active treatment
• Track equipment age, serial numbers, and maintenance logs for warranty and liability purposes
• Notify malpractice insurance carriers with complete, organised information
• Create audit trails for risk management and quality improvement programs

With Paperform's conditional logic, the form adapts based on whether the incident involved a patient, automatically showing or hiding relevant sections for incident details, injury descriptions, and witness information. You can attach photos of the damaged equipment, upload maintenance logs, and even collect digital signatures from staff members completing the report.

Once submitted, use Stepper to automate your response workflow: send immediate notifications to your practice manager and insurance broker, create tasks in your practice management system, log the incident in your risk management database, and trigger follow-up reminders for equipment inspection or replacement.

For practices that need additional documentation like incident acknowledgment forms or equipment service agreements, Papersign lets you turn submissions into professional documents ready for eSignature, keeping everything connected to the original claim for a complete paper trail.

Whether you're managing a solo practice or a multi-location chiropractic group, this template gives you the structure and professionalism needed to handle equipment damage incidents with confidence, protect your patients, and maintain compliance with insurance and regulatory requirements.