Haas 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. Please complete each section to its entirety and hit send at the end of the form. If you have not done so, please call our office to set up your appointment at 641-424-6531. We look forward to meeting you and helping you get well.

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