Chiropractic Care Forms
We provide excellence in chiropractic care to Eau Claire, Altoona, Chippewa Falls, and the surrounding communities.
Schedule your inital chiropractic consultation today!
- Chiropractic Registration and History Form
(in PDF format)
This form is necessary to process you as a new patient in our office. If you have any questions about filling in any section of this form, just ask us when you bring it in to our office for your initial visit or call us at the office.
- Patient Fill-In Accident History (Automobile Accident)
(in Word format)
If you have been in an auto accident, please fill in this two page form as completely as possible, and bring it with you to your initial visit along with the Chiropractic Registration and History form. It will help provide detailed information pertaining to your accident. If you have any questions, please contact the office.
- Nutritional Questionnaire
(in Word format)
This form and the following form are detailed questionnaires used to evaluate the need for specific nutritional supplementation. Please feel free to download and submit to the Doctors.
- Health Appraisal Questionnaire
(in PDF format)
 Note: You will need Adobe Acrobat Reader to view some of these files. If you do not have Adobe Acrobat Reader, download it. Best of all, It's free!
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