Synergy Chiropractic

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 be sure to answer EVERY Question. Leaving blanks will increase your time in the office and delay seeing the doctor.😢 When asked "the MAIN reason for your visit", enter only that reason. Additionally areas of concern will be asked at the end of the 1st page. Thank you!

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