Chiropractic Intake Form
Patient Intake Form for New Chiropractic Patients - REQUIRED FOR YOUR FIRST VISIT
This online form can be completed on a Windows PC ONLY. (Sorry - Online forms cannot be completed on mobile devices, IOS or Android devices).
IMPORTANT: PLEASE READ CAREFULLY BEFORE FILLING OUT THE ONLINE FORM BELOW: We ask that you be VERY detailed when filling out the forms. You will answer questions on your PRIMARY AREA OF COMPLAINT first. If there are additional areas of complaint, you will indicate that when you complete the questions for the primary complaint. You will be able to share up to 4 areas of complaint. When done, electronically sign the form and click SUBMIT to upload forms to our office. Please note that if the form is filled out incorrectly or incompletely, we must ask you to repeat this process when you arrive at our office, as this form cannot be modified.
We ask that the form be completed one day prior to your appointment so the doctor has time to review it before your arrive. If you are unable to complete the form at home, please arrive 20 minutes early for your appointment and you can complete the form in our office.
Click image below to fill out Intake Form
Other Forms and Downloads
Transfer of Medical Records Form
If you wish to transfer medical records to our office from another doctor; or from our office to another office, please download and print the following release form. You can bring the form into our office or fax it to us.
Click image below to download Medical Records Release Form
Click here to download Food Diary form
The Page Fundamental Diet Plan
Click here to download Page Diet Plan
Cannot open the forms? If you do not already have AdobeReader® installed on your computer, Click Here to download.