Skip to content

New Patient Forms

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


Health History

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

pdf iconDownload & Print Form


General Pain Index

Additional form for patients with Medicare.

pdf iconDownload & Print Form


Neck Questionnairre

Additional form for auto or work injuries with neck pain.

pdf iconDownload & Print Form


Back Questionnairre

Additional form for auto or work injuries with lower back pain.

pdf iconDownload & Print Form


Free AdobeReader®

Get adobe readerEach 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.


Chiropractic Health & Wellness Clinic Forms | (515) 270-6737