New Patient Paperwork

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!

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.

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!

Chiropractic Forms

Adult intake form

Child Intake Form

Infant Intake Form

Symptom Survey Form

Nutrition Response Testing® Forms

READ FIRST - Orientation

Symptom Survey Form

Food Intake Journal

OFFICE HOURS


Monday
11:00am - 6:30pm


Tuesday
1:00pm - 6:30pm


Wednesday
8:00am - 2:00pm


Thursday
Closed


Friday
7:00am - 2:00pm


Saturday
Closed

Back to Wellness Chiropractic
284 Nugent Street
St Paul, MN 55102
Phone (952) 693-3736
Fax (651) 925-0073