Online Paperwork
We want to thank you for considering our office. Below are the forms that we need to help us assess your overall health and wellness. Please carefully complete them and bring them with you on your visit to the office. Your answers will help us determine if our care can help you. If we do not sincerely believe your condition will respond satisfactorily, we will not accept your case but will work to refer you to the appropriate healthcare provider. If you need help with this form, please do not hesitate to ask.
Our goals are to first address the issues that brought you to this office and second to offer you the opportunity of improved health, wellness and quality of life in the future. On a daily basis we all experience physical, biochemical, and psychological/emotional stresses that can accumulate and result in serious loss of health potential. Most times the effects are gradual and may not even be felt until they become serious. Answering the following questions will give us a profile of specific stresses, past and present that you face and allow us to better assess the challenges to your health potential.
We look forward to meeting you,
Dr. Michael Gibson & Dr. Ryan Pope
Chiropractic Health History
This let’s us know what’s happened, but perhaps more important, where do you want to take your health?
Adult Chiropractic Health History Form
Children's Chiropractic Health History (children under 12 years of age)
Free AdobeReader®
Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.
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