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Online Forms

We offer our paperwork on line so you can complete it in the convenience of your own home.


Health History

This let’s us know what’s happened, but perhaps more important, where do you want to take your health.

New Patient Intake Form

Activity Pain Scale

Neck Pain Disability

Headache Disability

Revised Oswestry Low Mid Back Pain Disability

Roland-Morris Low Back


Release of Records

If you have received chiropractic care elsewhere, or have medical records we will need from another practitioner, please sign this release. pdf iconDownload & Print Form


HIPAA Acknowledgement of Receipt 

HIPPA Notice of Privacy Practices


Automobile Accident

If your health issue is the result of a car accident, we need some additional information. pdf iconDownload & Print Form


Worker’s Compensation

If your health issue is the effect of an injury at work, this information will help us help you. pdf iconDownload & Print Form


Free AdobeReader®

Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

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