Butler Chiropractic

Patient Intake Form

Welcome to Dr. Butler's office and our online Patient Intake Form. The information you fill in will be sent directly to our office, speeding up your office visit and allowing us to better serve your healthcare needs. 1) Tell us a little bit about you. 2) Click on the body image provided and give us a detailed description of ONE condition that you are experiencing. 3) When asked, "Do you have an additional condition," click "Yes/No." This allows you to describe each complaint, one at a time.

Who are you?