Haanen-Zilisch-Smith Chiropractic Clinic offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Completing the forms in advance and bringing them with you can help you save time at your initial visit.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form - Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Neck Pain Index
Please print and fill out this form along with the new patient form if you have been experiencing neck pain.
Low Back Pain Index
Please print and fill out this form along with the new patient form if you have been experiencing low back pain.
Headache Index
Please print and fill out this form along with the new patient form if you have been experiencing headaches.