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.

Please complete the appropriate intake prior to your appointment! Not having the intake done prior to your appointment will cause delays in the doctors schedule! 

While we offer paper intakes, this is not a preferred method because we have to manually enter information, which is sometimes not legible, and takes extra time. This will likely cause delays in receiving your report, if for animals, because we might not guess correctly on what was written.

Human Intake Form

Equine Intake Form

Canine Intake Form

Canine 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.
  • 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.
  • Date Format: MM slash DD slash YYYY
  • :

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.
  • Date Format: 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.