New Patient Intake Forms

We prefer that all new patients complete the health history form.

Health History Form (PDF)

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:

If we have requested you to complete a different form, it can be found below. Pietila 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 Information Form (PDF)

Metabolic Assessment Form (PDF)

Neurotransmitter Assessment Form (PDF)

HHK Adult Assessment Form (PDF)

HHK (Under 18) Assessment Form (PDF)