Patient Intake Forms

Please ensure all paperwork is filled out 24 hours prior to your appointment. If this paperwork is not complete prior to the time of your appointment, we will need to reschedule your appointment. This will help ensure that all patients stay on schedule.

Nutrition Patients

  • Patient Symptom SurveyOur staff will be sending you an email containing a link to your own unique Patient Symptom Survey for you to complete.
  • Patient QuestionnaireClick this link, fill out the form and submit online; do not print off.
  • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
  • Patient Release Form – Click this link, fill out the form and submit online; do not print off

Chiropractic Patients

  • Patient QuestionnairePlease print off, fill out and bring with you on the day of your appointment.
  • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
  • Patient Release Form – Click this link, fill out the form and submit online; do not print off.

Acupuncture Patients

  • Acupuncture (Male) – Please print off, fill out and bring with you on the day of your appointment.
  • Acupuncture (Female) – Please print off, fill out and bring with you on the day of your appointment.
  • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
  • Patient Release Form – Click this link, fill out the form and submit online; do not print off.

Thermography Patients:

Breast Thermography

If you made an appointment for a  full or half body scan or a full or half body scan plus breasts, please see the next section.

Half Body scans; Half Body + Breast scans; Full Body scan; Full Body + Breast scan

PEMF Therapy Patients

  • Patient Questionnaire – Click this link, fill out the form and submit online; do not print off.
  • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
  • Patient Release Form – Click this link, fill out the form and submit online; do not print off.
  • PEMF Questionairre – Please print off, fill out and bring with you on the day of your appointment.

Kinesio Taping Patients

  • New Patient Questionnaire – Please print off, fill out and bring with you on the day of your appointment.
  • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
  • Patient Release Form – Click this link, fill out the form and submit online; do not print off.