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Online Paperwork

We offer our paperwork on line 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 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, or print from link below)

New 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, or print from link below)

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:

MEDICARE ABN FORM 2016