---
title: Chiropractic X-ray Consent Form Template with Radiation Disclosure | Paperform
description: Professional X-ray consent form for chiropractors with radiation risk disclosure, pregnancy screening, positioning instructions, and electronic signature capture. HIPAA-aware and fully customizable.
url: "https://paperform.co/templates/chiropractic-x-ray-consent-screening-form"
type: static
generatedAt: "2026-03-28T00:43:18.748Z"
---

[← Back to free form templates](/templates/)    ![Chiropractic X-ray Consent & Screening Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/chiropractic-x-ray-consent-screening-form.png)
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### Chiropractic X-ray Consent & Screening Form

Ensuring patient safety and informed consent is fundamental to quality chiropractic care. This **Chiropractic X-ray Consent & Screening Form** streamlines the process of obtaining proper authorization before performing diagnostic X-ray imaging, while capturing critical screening information and educating patients about the procedure.

#### Why chiropractors need a digital X-ray consent form

X-ray imaging is a valuable diagnostic tool in chiropractic practice, helping practitioners visualize spinal alignment, identify structural issues, and develop targeted treatment plans. However, X-rays involve exposure to ionizing radiation, making proper informed consent and safety screening essential—not just for patient care, but for regulatory compliance and risk management.

Traditional paper consent forms can be time-consuming to manage, difficult to store securely, and easy to misplace. This Paperform template digitizes the entire process, allowing patients to complete their X-ray consent and screening questionnaire before their appointment or in the waiting room on a tablet. Submissions are instantly recorded, easily searchable, and can trigger automated workflows to keep your practice running smoothly.

#### What this form includes

This template covers everything needed for compliant X-ray consent:

 - **Comprehensive radiation risk disclosure** that explains the procedure, benefits, and potential risks in clear language
 - **Pregnancy screening questions** to identify patients who may need alternative imaging or additional precautions
 - **Medical history relevant to X-ray safety**, including prior radiation exposure and current health conditions
 - **Positioning and procedure instructions** so patients know what to expect
 - **Report delivery timeline** to set clear expectations about when results will be available
 - **Full informed consent documentation** with electronic signature capture

The form uses conditional logic to show follow-up questions based on responses—for example, if a patient indicates they might be pregnant, additional screening questions appear automatically.

#### How Paperform enhances your chiropractic practice

Beyond simple data collection, Paperform helps chiropractors create professional, HIPAA-aware forms that integrate with your practice management workflow:

 - **Brand your forms** to match your practice's visual identity, building trust and professionalism from the first touchpoint
 - **Capture legally binding signatures** right in the form, eliminating the need for printing and scanning
 - **Automate follow-up** by connecting to your email system or CRM to send appointment reminders, results notifications, or educational materials

For practices that need even deeper workflow automation, **[Stepper](https://stepper.io)** can route completed consent forms into your practice management system, notify the radiography team when a new consent is ready, or trigger different workflows based on screening responses—all without manual data entry.

Whether you're a solo practitioner or managing a multi-location chiropractic clinic, this template provides the foundation for safe, compliant, and efficient X-ray consent collection that protects both your patients and your practice.

Get started with Paperform's Chiropractic X-ray Consent & Screening Form today and transform your patient documentation from paperwork hassle into seamless digital workflow.
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