Center for Health & Wellness

For your convenience, our intake forms are available for download. Please select the appropriate new patient form by clicking below. Please print, fill out, and bring the appropriate form with you to your first appointment.

New Patient Forms

New Chiropractic Patients

New Chiropractic Patient Form (pdf)
New Patient Chiropractic Motor Vehicle Injury Form (pdf)
New Patient Chiropractic Work Injury Form (pdf)

New Pediatric Patients

New Patient – Pediatric (pdf)

New Massage Patients

Massage New Patient Form (pdf)

 

Returning Chiropractic Patients

If you are an existing patient and have a new injury or have not been seen in this office in a year or more, please download, print, and fill out the form below. If your personal information has changed since your last visit, please let us know. Otherwise, just write “same” in all personal information fields that have not changed.

Returning Chiropractic Patient Update Form (pdf)

 

NOTES: 

  • Please fill out the forms in their entirety as best you can.
  • Please be as thorough as you can with past health and family health history, feel free to use an extra sheet of paper if needed.
  • Please read and fill out all areas of the consent to treat form, if you have questions before filling out any of the forms please don’t hesitate to call the office.

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