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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.
Click to upload file
New Patient Intake Form
Established Patient Intake Form
Patient Privacy (Existing patients)
Consent To Use PHI (Protected Health Information)
Metabolic Assessment Form (thyroid, AI, diabetes, etc.)
Motor Vehicle Accident Questionnaire

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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
  • ADD/ADHD
  • Anxiety / Stress / PTSD
  • Memory Loss
  • Fatigue
  • Brain Injury
  • Depression
  • Fibromyalgia
  • Insomnia / Sleep Issues
  • Learning Disabilities
  • Autism
  • Epilepsy / Seizures
  • Addiction
  • Stroke

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