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Online Patient Intake Forms

These PDF forms are fillable online!

Easy 4 step process

  1. Click a form below (it will open in a new tab).
  2. Fill out the form in your browser.
  3. Save the form to your computer.
  4. Upload the form using the uploader below.

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Musculoskeletal Conditions
  • Headaches
  • Neck Pain
  • Low Back Pain
  • Carpal Tunnel
  • Tennis Elbow
  • Shoulder Pain
  • Rotator Cuff
  • Knee Pain
  • Plantar Fasciitis
Condition Specific Services
  • Diabetes
  • Thyroid / Hashimoto’s
  • Neuropathy / Foot Tingling
  • Anxiety / Stress / PTSD
  • Memory Loss
  • Fatigue
  • Brain Injury
  • Depression
  • Fibromyalgia
  • Insomnia / Sleep Issues
  • Learning Disabilities
  • Autism
  • Epilepsy / Seizures
  • Addiction
  • Stroke

Upload Your Forms Below

We are proud to serve the Tri-State area, including Evansville, Henderson and Southern Illinois

Your Journey to a Healthier Life Starts Here

Are you ready to take control of your health and get the answers you are looking for?