Adjustments Chiropractic and Wellness

by Dr. Aivalotis
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If you are a new patient, please print the appropriate forms below and have them filled out before your first visit.  Make sure to sign in the appropriate areas.  We will need to copy your insurance card and a photo ID when you arrive for your visit. 
 
 
 
FOR CHIROPRACTIC PATIENTS:                                                     FOR NUTRITION PATIENTS:                    
Confidential Patient Health Record                                                          Nutrition Patient Qustionnaire
 
Current Health Condition                                                                        Patient Symptom Survey
 
Assignment and Release                                                                          HIPAA Consent  
 
 
 
If you've been invloved in an AUTO ACCIDENT, use these forms instead:
 
 
Confidential Patient Health Record                                                         
 
Current Health Condition                                                                       
 
Assignment and Release