Butler Chiropractic


Patient Intake Form

Welcome to Butler Chiropractic 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) You will be asked a short series of questions 2) Then, Click on the body image provided and give us a detailed description of ONE condition at a time 3) When asked, "Do you have an additional condition," click "Yes" if you wish to describe more than one area of complaint.

Who are you?