We’re Excited to Work with You!

When you visit our office for the first time, there will be just a small amount of paperwork that provides us with some general information about your condition, history, etc. If you would like to fill-out the forms in advance and bring them in with you to save time, you can view, download, and/or print the forms here:

Click Here to Print New Patient Forms

Your fist visit won’t take too long, but long enough for us to accurately determine what is wrong and what we can do to help relieve your pain. A typical visit includes the following:

  • Consultation – You will spend some time talking to the doctor about your problems and any concerns that you might have. The doctor will then talk about possible treatment options.
  • History and Examination – The more we know about the history of the problem, and the more thorough the examination, the more accurate our assessment and treatment will be. We perform a variety of specialized tests to make sure we correctly identify the problem.
  • Digital X-Ray Studies – If necessary, we’ll take X-Rays and examine things more closely from the inside. This is usually reserved for more serious problems.
  • Treatment – Based on our findings from the above steps, a treatment plan will be recommended. There may be more than one option, and it might even be a quick and easy fix.
  • Home Instructions – Once we know what is wrong, we’ll tell you how to avoid repeating the injury, making it worse, and how to make things better when you aren’t visiting us. These instructions and exercise are extremely important, and can make or break the effectiveness of your treatment plan.
  • Schedule Your Next Appointment – Treatment is more effective when performed regularly and relatively close together. Always remember to set-up your next chiropractor appointment, and please don’t miss an appointment! Missed appointments often mean a backslide in treatment effectiveness.

If you have any questions, please don’t hesitate to Contact Our Chiropractic Office today!

Get a Free Consultation Now!

New Patient Questionnaire

Dear Patient:

Please fill out this questionnaire as completely as possible. Your answers will help us determine if chiropractic therapy can help you. If we do not believe your condition may respond satisfactorily, we will not accept your case. Thank you.

ALL INFORMATION SUBMITTED VIA THIS FORM IS CONFIDENTIAL AND ENCRYPTED

Personal Information

















(Guaranteed secure and encrypted transmission)


Emergency Contact

In case of emergency, please provide the name of a relative or close friend not living in your home.







Medical History

Please choose the appropriate level of frequency for each of the following symptoms which you now have or have previously experienced. We can all the facts about your health before we accept your case. ALL FIELDS IN THIS SECTION ARE REQUIRED

Muscle & Joint

Pain or numbness in:

Other

General


 Alcoholism Appendicitis Cancer Diabetes Epilepsy Gout Heart Disease Miscarriage Stroke HIV/Aids

Family Health Information

Many health problems are the result of hereditary spinal weaknesses; thus, information about your family members will give us a better idea of your total health picture. If any of your family members have suffered from cancer, stroke, heart disease, diabetes, or spinal conditions, please specify below.




 Cancer Stroke Heart Disease Diabetes Spinal Conditions




 Cancer Stroke Heart Disease Diabetes Spinal Conditions




 Cancer Stroke Heart Disease Diabetes Spinal Conditions




 Cancer Stroke Heart Disease Diabetes Spinal Conditions

Other History Questions


 Yes No

If yes, what was the date of your last care and your previous doctor's name?




 Yes No


Chief Complaint











 Constant (always present) Intermittent (comes and goes)


 Work Sleep Daily Routine Other


 Yes No




 Ice Heat Medications Lying down Standing Sitting Walking Other Nothing


 Standing Sitting Walking Running Exercising Coughing Other Nothing


 Sharp Stabbing Shooting Dull Achy Burning Throbbing Other






 Pain Killers Anti-inflammatory Muscle Relaxants Anti-depressants Blood Pressure Cholesterol Other


 Past year Past five years Over five years ago Never



 Yes No



 Yes No



 Yes No


 Yes No

Medical Information








 Yes No

Privacy Practices

Please read our HIPAA Compliance Privacy Practice Notification


   I accept

All information sent using this questionnaire is 100% secure and confidential.