New Patient Intake Forms
We prefer that all patients complete the New Patient Application prior to their arrival for their first appointment.
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
- MRI/CT scan
- Diagnostic Ultrasound
- Electrodiagnostic studies
- 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 PDF
Established Patient Update Information Form PDF
Motor Vehicle Accident Questionnaire PDF
Workers Compensation Questionnaire PDF
NeuroMetabolic Assessment Forms:
Neurotransmitter Assessment Form PDF
HHK (Under 18) Assessment Form PDF
Brain Region Localization Form PDF