Health Intake Form
Please fill out demographic information and let us know any allergies you may have and any medications your are currently taking.
Please sign stating you understand that we treat certain ailments in our clinic using specific chiropractic methods.
Please sign stating that you understand what chiropractic care is and consent to our treatment.
Please sign stating that you understand and agree to our notice of privacy policies.
Please sign stating that you have read and understand our clinic policies.
If patient is under the age of 18 please sign confirming your consent to treat. Additional minor paperwork will be provided upon arrival in the office.