Intake Forms

We prefer that all patients complete the New Patient Application prior to their arrival for their first appointment. It can be found in the welcome email, or via the link below.

New Patient Intake Form

Patients whose conditions require significant neurological or metabolic assessments and treatment, or have complex case histories, will need to provide us with a copy of their pertinent health records prior to the initial assessment. Please call our office to start the process.

Please include health information relative to your current condition:

Health History
Exam or treatment records
Lab testing/Blood work
X-rays
MRI/CT scan
Diagnostic Ultrasound
Electrodiagnostic studies
EEG
Medications/Supplement list
Current diet and/or restrictions

If we have requested you to complete a different form, it can be found below. NeuroTarget Chiropractic must receive your records prior to setting up your initial appointment. After the doctor has reviewed the information and determined you may be a candidate for care, our office staff will contact you to schedule your initial consult and examination. Feel free to fax, email, or mail them to our clinic ahead of time. Please see our contact information for more details.

New Patient Child Intake Form

Established Patient Update Information Form

Motor Vehicle Accident Questionnaire

Workers Compensation Questionnaire

NeuroMetabolic Assessment Forms:

Metabolic Assessment Form

Neurotransmitter Assessment Form

HHK Adult Assessment Form

HHK (Under 18) Assessment Form

Brain Region Localization Form

Food and Exercise Log

Digestive Health Questionnaire