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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.

Watch Our How To Videos For:

Computer/Laptop Users

Mobile Phone Users

Scan or Click The QR Code to Complete Forms

QR Code for JotForm form

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


Heart Sound Recorder Clients:

Heart Sound Recorder Questionnaire

 

New Chiropractic and Nutrition Patients:

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

Instructions for New Patient (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, SAVE as pdf to your desktop and email to us

SP Stress Assess online fillable form, SAVE as pdf to your desktop and email to us

Sleep Questionnaire online fillable form, 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:

2021 Medicare ABN

Supplement Purchase Intake Form

Authorization to purchase supplements


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