Forms
New Patient Forms
Fill out your paperwork before you arrive. Read and accept the consent, complete the form on this page, then print it and bring it with you.
Step 1
Acknowledge, then complete your form
Everything you enter stays in your browser, nothing is stored or transmitted. If you would rather fill the paperwork out in person, arrive about 15 minutes early and the front desk will have it ready.
Forms are also kept at the front desk. Call the office at (970) 242-1903 and we can send them to you ahead of your visit.
New Patient Intake Form
Contact details, health history, and current concerns.
Included below
Patient Health History
Previous injuries, surgeries, conditions, and medications.
Included below
Privacy Practices Acknowledgement
Acknowledgement of the practice's privacy notice.
Included below
Let us get started filling out this form.
Complete it here at your own pace, then print it and bring it with you. Nothing is stored or sent over the internet.
Before you begin, please confirm you understand:
- You consent to a chiropractic exam and any recommended treatment, therapy, or imaging.
- You agree to provide accurate, complete health information and tell us about any health changes.
- Your typed full name counts as a legal electronic signature, just like a handwritten one.
- You can request a copy of our privacy notice, and payment is expected at the end of each visit.
- You consent to a chiropractic exam and any recommended treatment, therapy, or imaging.
- You agree to provide accurate, complete health information and tell us about any health changes.
- Your typed full name counts as a legal electronic signature, just like a handwritten one.
- You can request a copy of our privacy notice, and payment is expected at the end of each visit.
Check the box above to unlock the form.
Your form is ready to print
Nothing has been stored or transmitted. Print this page (or save it as a PDF) and bring it to your first appointment at 1445 N 7th St, Grand Junction. Prefer a mailed copy? Call (970) 242-1903.
Help
Trouble with the forms?
Call the office at (970) 242-1903 and we will help. Please do not email completed forms containing health information, bring them with you instead.
Related Pages
Next step
You Don't Have to Keep Planning Your Life Around Pain.
If pain is affecting the way you sleep, work, exercise, travel, or spend time with the people you love, it is worth finding out what is going on. Let's start with a conversation.
Engage With Your Life Again.