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New Chiropractic Patient Online Forms

Back to Wellness Chiropractic offers new patient intake forms online that can be quickly printed and completed prior to your appointment! This can save you and your family some time at the office!

Please let us know the history and current state of your health. Do you suffer from nagging low back pain, headaches, and/or colds? How about reoccurring sinus troubles, constipation/diarrhea, or acid reflux? Or do you not have any particular health issues but want to increase your overall health in general? How can we help you? Let us know!

Adult Intake Forms

Child Intake Forms

Infant Intake Forms

Toxicity Questionnaire

Food Intake Journal

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Bring the forms with you to your appointment or conveniently fax them in!


Download the Free AdobeReader®

Location

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Office Hours

Our Regular Schedule

Monday:

11:00 am-6:30 pm

Tuesday:

1:00 pm-6:30 pm

Wednesday:

8:00 am-2:00 pm

Thursday:

Closed

Friday:

7:00 am-2:00 pm

Saturday:

Closed

Sunday:

Closed

Testimonials

Reviews By Our Satisfied Patients

  • "Kayla brings a fearlessness and love of learning to her industry that is refreshing. She is an excellent problem solver and is willing to explore new ideas to give relief to her clients."
    Peter B.
  • "Dr. Kayla has worked closely with me to help improve the health of my neck and back so that I have gone from no golf or basketball back to playing without pain at least once a week. Thanks for your great work."
    Tom K.
  • "Dr. Kayla is a very good representative of what a Dr. should be. She is very passionate about what she does and it comes through in her work and in her results. I like that a huge part of her practice is education. She continually takes time to explain and educate each of her patients. I will continue to refer to Dr Kayla as I trust in her skills and her knowledge."
    Christine K.