Crossroads Chiropractic Clinic


Patient Intake Form

Welcome to 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. If you are unable to complete prior to your appointment, please arrive 30 minutes early to complete in the office otherwise your appointment will be rescheduled. For more than one area of complaint, please CHECK THE "YES" on the question at bottom of the REASON FOR VISIT page that asks...........DO YOU HAVE AN ADDITIONAL CONDITION?PLEASE IGNORE SEXUAL ORIENTATION QUESTION, WE CANNOT REMOVE IT.

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