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25807 Westheimer Pkwy #270 Katy, TX 77494

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New Patients Receive a Free Consultation

Online Forms

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

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 

Authorization for Release of Medical Records

Nutrition Forms

Food Diary

Click here to download Food Diary form

Food Diary Form

The Page Fundamental Diet Plan

Click here to download Page Diet Plan

Page Diet Plan

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