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Please explain the reason(s) for visiting the chiropractor
How long this has been an issue
Please list any medications you are taking and the reason for its use
Please list any operations, including the approximate year.
Please list any chronic illness.
Please read below and check the box if you understand and agree
Please arrive at least 5 minutes before your appointmentFor hygenic reasons, please arrive showered and clean to your appointment. (It’s important you don’t come in sweaty and rushed).Appointments can start later occasionally because we want to provide the care that is needed to everybody. We ask you upfront for your understanding and do our utmost best to prevent any delayOur time is just as valuable as yours, please inform us 24 hours prior to your visit if you want to reschedule. Later cancellations or missed appointments without notice will be charged the full price of the visit.We strongly encourage patients who are feeling ill to maintain their appointments. Chiropractic adjustments improve the function of the nervous system, and positively impact the immune system.
It is required to bring your BSN (identification) to your first visit and if applicable please bring your Health insurance number as well