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Patient Forms

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


Nutritional Evaluation Forms

Contact office for examination package

Chiropractic Forms

New Patients

  1. Application for Care
  2. Functional Difficulty in Performing Activities of Daily Living (A.D.L.’s)
  3. Acknowledgment of Privacy Practices
  4. Functional Awareness Questionnaire
  5. Informed Consent for Treatment
  6. Stress Test
  7. Financial Policy
  8. Easy Patient Insurance Verification
  9. About Medicare Coverage
  10. 2016 System Survey – printable version
  11. System Survey- online version

Massage Therapy Forms

  1. Massage therapy waiver consent form
  2. Personal Preferences

Reflexology Forms

  1. Reflexology Consent/ Waiver form
  2. Ionic Cleanse Foot Bath Release Form

Body in Motion Yoga Form

  1. Yoga Waiver / Release Form

Free AdobeReader®

Each download 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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