Kaplan Family 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.**When you get to the Reason for Your Visit page, please make sure to answer for your primary complaint ONLY, using the picture and questions under "Select all adjoining areas that are causing you pain or discomfort for this condition". If there are additional areas of concern, you can then click on "Do you have an additional condition" on the bottom of the page for each different complaint.

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