Kambeitz Chiropractic Health & Wellness Center, P.C. offers our patient form(s) online so you can complete it in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form - Required
This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Medical Questionnaire - Required
Fill us in with your medical history so we can better plan for your care in the clinic and any conditions that may affect your treatment protocols.
Patient Policies - Required
Please review and sign our patient policies form before starting treatment at our clinic.
New Patient Pediatric Health History Form
This let's us know the history and current state of your child's health. What questions, concerns, goals, regarding your child can we help you with? Let us know!
New 8WW Participant Forms
Patients who will be participating in our 8 Weeks to Wellness program have a medical symptoms questionnaire and health satisfaction survey to fill out prior to starting the program.