New Patient Paperwork

Thank you for considering Back To Health Chiropractic – Let’s get started!

Back to Health Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or 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.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Step 1

Complete the Health History Questionnaire. Once you have completed this form, click the Submit button and it will be electronically sent to us.

Health History Questionnaire


Attention Parents/ Guardians: If you have a child age 4 or under, you will need to print out and complete the Pediatric History Form and not the Health History Questionnaire listed above. Bring this form with you to the office for your first appointment!

Pediatric History


Step 2

Print out and complete the Signature Pages. Bring these forms with you to the office for your first appointment!

Signature Pages


Step 3

Complete the Functional Assessment Questionnaire online. This health review takes approximately 30 to 40 minutes to complete.

Functional Assessment Questionnaire online


Softwave Therapy Initial

Complete the Softwave Therapy Questionnaire online.

Softwave Therapy Questionnaire

Hours of Operation

Our Regular Schedule

Monday

7:00 am - 11:00 am

Tuesday

7:00 am - 10:00 am

Wednesday

8:00 am - 11:00 am

Thursday

7:00 am - 11:00 am

Friday

7:00 am - 11:00 am

Saturday

Closed

Sunday

Closed

Monday
7:00 am - 11:00 am
Tuesday
7:00 am - 10:00 am
Wednesday
8:00 am - 11:00 am
Thursday
7:00 am - 11:00 am
Friday
7:00 am - 11:00 am
Saturday
Closed
Sunday
Closed

Location

See us on the map!

chiropractic spine

WHERE IS YOUR PAIN?

Learn how we can help with your pain