Skip to content

Man filling out paperwork

New Patient Forms

Save time during your first visit

At Chiropractic Health & Wellness Clinic, 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?

General Pain Index

Additional form for patients with Medicare.

Neck Questionnaire

Additional form for auto or work injuries with neck pain.

Back Questionnaire

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


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