Chiropractic Forms


Dear Patient,

Thank you for scheduling your chiropractic appointment with us.

In an effort to assess your health concerns please print and then fill out the nutritional questionnaires. Please do not email your completed forms back to us.  Bring the completed forms with on your scheduled appointment date.

We have included the “Pain Scale” that defines the intensities and types of pain.  Please use this as a guide to define your pain scale. You will fill this out just before your appointment, so there’s no need to print them out prior. (Attachment 6c and 7c)

Should you have any recent imaging studies: x-rays, MRI’s or CT’s of the area of complaint please provide us with a copy. 

We look forward to meeting you and addressing your back/neck concerns.

Missed Appointment Policy – cancellation or reschedule with 24 hr. notice – no charge (leave a message on answering machine between office hours or days we are closed).

Office Hours:
Monday 9-2, 4-6
Wednesday 9-2, 4-6
Friday 9-2
1st & 3rd Saturday 9-1

Thank You,

Achieve Health Chiropractic and Clinical Nutrition

Please complete all of the following forms

Patient Registration

Informed Consent for Chiropractic Treatment

HIPAA and Medicare;
Consent to use PHI

Explanation of Fees

Chiropractic Health Questionnaire

Neck Pain and Disability Index

Oswestry Questionnaire