Initial Exam Forms
Below are the forms you will need for your upcoming appointment. Please fill out the appropriate form completely and hit the submit button.
Pediatric Health History
Please use this form for anyone 14 years and younger.
Adult Health History
Please use this form for anyone 15 years and older
Pregnancy Health History
Why This Form Is Important
Our focus is on assisting clients to function optimally, for them to become more self aware, stronger, healthier and for improved adaptation to everyday stresses.
Completion of this form provides us with an improved understanding of your physical, emotional and chemical stresses that can gradually overwhelm the body over time and contribute to health problems. Please complete this form as thoroughly as possible and the doctor will review it with you. Information on this form is strictly confidential and will not be shared without your consent.