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patient forms

FORMS FOR ADULT AND CHILDREN PATIENTS

Please download, print, and complete the following forms and bring them with you on your first visit. If you have a child who receive chiropractic care, please complete the forms for children in addition to the adult forms. Thank you!

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Adult Welcome Form

Lifestyle Rating Scale

Patient History

Children's Health and Wellness Intake Form
(For children ages six and under)

General Function Capacity Questionnaire

Low Back Pain and Disability Questionnaire

Privacy Notice

Fee Schedule

Neck Disability Scale

Children's Consent Form
(For children ages 18 and under)

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