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Online Paperwork

We offer our paperwork online so you can complete it in the convenience of your own home.

Below are the essential forms we use.

Call our Fair Oaks chiropractic office or click here to email us your questions.

Scan to Complete

QR Code for JotForm form

New Chiropractic and Nutrition Patients:

Please complete & return at least 2 business days before your appointment.

New Patient Instructions  (please read carefully so you are prepared for your first visit)

Online Confidential Health History Form (complete online, PRINT or SAVE as pdf to your desktop first, THEN click Submit)

* Systems Survey (you will receive a secure email login from Michelle to do this form, preferred method, or print from link below, alternate)

Utilice este formulario en español como una guía para su línea Systems Survey: Systems Survey Spanish

Remote Nutrition Patients:

ZYTO Hand cradle loan agreement for REMOTE patients  (form must be completed prior to scheduling appointment)

As Directed by Doctor (not needed for initial visit):

SP Toxicity Questionnaire Online Fillable Form complete online, SAVE as pdf to your desktop and email to us

SP Stress Assess Online Fillable complete online, SAVE as pdf to your desktop and email to us

Sleep Questionnaire Online Fillable Form complete online, SAVE as pdf to your desktop and email to us


SYSTEMS SURVEY (NOTE: CROSS OUT the symptoms that don’t apply. Do NOT leave anything blank.)


Additional forms as needed:

Social Adjustment Rating Scale – Online Fillable

Medicare Patients:


Supplement Purchase Intake Form

Authorization to purchase supplements

LeMay Chiropractic & Wellness Forms | (916) 965-8171