General Intake Form

Please download the form below prior to your scheduled office visit.

Cash payment is only available through ChiroHealth USA. CHUSA is a discount club which requires a $49.00 yearly annual membership fee to lock in discounted pricing. To learn more about CHUSA, please contact our office.

Our office requires the chiropractor to review the patient records before receiving any services. This includes massages, since there are some conditions that are contraindicators to receiving a massage.