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
Intake Form
Symptom Survey Form
Food Intake Journal
OFFICE HOURS
Monday
11:00am - 6:30pm
Tuesday
8:00am - 3:00pm
Wednesday
Closed
Thursday
3:00pm - 6:30pm
Friday
7:00am - 2:00pm
Saturday
Closed
Back to Wellness Chiropractic
284 Nugent Street
St Paul, MN 55102
Phone (952) 693-1565
Fax (651) 925-0073
