Intake Forms for all Chiropractic Patients

Please complete one intake for each individual patient

The intake forms below are for all the different types of patients we are able to treat. Each form is loaded into the patient's profile for notes, and records. To enter another intake, please click here after your previous entry has been confirmed.

Intakes are required for all new patients and patients that haven't been seen in 2+ years. Please have the appropriate intakes completed 24 hours prior to your appointment! Please do not enter an intake without scheduling an appointment or calling/texting us. Not having the intake done prior to your appointment will cause delays in the doctors schedule!

Equine Intake Form

Canine Intake Form

Canine Intake Form:

"*" indicates required fields

Owner's Address*
Does the animal have a job or discipline? This would be something like a service dog, military or police, special training, or a companion animal.
Is the animal Spayed or Neutered?*
MM slash DD slash YYYY
Purpose of visit:*
Time of injury
Name of Veterinarian
Veterinarian Address
Previous Xrays

Human Intake Form

Other Species Intake Form

Other Species Intake Form:

  • We enter the owners information, like date of birth, into our electronic health records for accurate information. If no date is provided, we use the date of initial service. This information is used when scheduling online for human chiropractic visits.
  • Name of the animal or a way to identify
  • Where the animal is stabled/resides at.
  • MM slash DD slash YYYY
  • :
  • For Chiropractic visits for animals other than equine and canine, the treating vet is required to be present during the treatment.