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Patient Forms

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Patient Forms 2017-05-12T00:48:18+00:00

When a patient seeks chiropractic health care and we accept a patient for such care, it is essential for both to be working for the same objective.

Includes new adult patient intake form, terms of acceptance, new patient HIPAA privacy form, and notice of privacy.

Please fill out these forms before your first visit. Click here to download.

Includes new pediatric patient intake form, terms of acceptance, new patient HIPAA privacy form, and notice of privacy.

Please fill out these forms before your first visit. Click here to download.

This questionnaire will give your provider information about how your condition affects your everyday life.

Please answer every section by marking the one statement that applies to you.
Click here to download.

Success Stories

“My neck after several adjustments feels wonderful!!! I can sleep and feel rested. I can turn my neck left and right. I feel much happier and now I have a desire to do household tasks with pleasure. I want to go places and meet people again. I feel like a young woman at 64 years.”

– M. Rice

Read Testimonials