Patient Intake Forms - Alliance Chiropractic and Wellness

Patient Intake Forms

Help us help you. All patients are required to complete a health intake form prior to their first appointment. This information helps us understand your health history so we can properly treat and manage your specific concern (acute care) or ensure you stay pain and symptom free (wellness care).

Chiropractic Care

Pediatric Health History form

For children under 12 years

See to the right, or click here.

Adult Health History form

For patients 12 years old and above

See to the right, or click here.

Massage Therapy

Massage Health History form

See to the right, or click here.

Naturopathic Medicine

Pediatric Health History form

(for patients ages 0 to 12 years)

See to the right, or click here.

Adult Health History form

(for patients ages 12 and above)

See to the right, or click here.