Online Forms

At Chiropractic Health And Wellness Center, your first visit will begin with a warm smile and personal greeting! Our front desk and chiropractic assistants will greet you by first name unless otherwise requested. We have provided our new patient forms in the New Patient Center for your convenience. This paperwork is our first insight to your overall health and spinal conditions and is vital to initiating your care. Please provide us with the best phone numbers and contact information so we may reach you to discuss your care. We ask that you plan to be in our office a total of two hours for your first in office visit.

If for some reason you will not be able to make your appointment, we request you notify us 12 hours in advance, so that another person in need of the doctor’s time may be seen.

Chiropractic Health And Wellness Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Bring the completed form with you to your appointment.

Patient Application Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

HIPPA

Please read the Patient Privacy Act. The forms to sign are included with the patient application form download. We do not need a printed version of the entire Act, just the forms included with the Patient Application Form.