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Foley Wellness Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

Your First Visit Includes:
 

  • A patient history to determine how your activities and lifestyle affect your condition.
  • A thorough 3-part exam to help determine the physical problems you have and the causes of your condition.
  • Diagnostic testing, therapies and chiropractic treatment as indicated by the results of your history and examination.
  • A referral to another health care provider, or for x-rays, if needed.

If possible, please fill out the appropriate intake form before you arrive.

Patient Intake Forms

Download & Print Age 13 to Adult Form
Download & Print Age 1 to Age 12 Form
Download & Print Birth to Age 1 Form

Patient Update Form

Download & Print Update Form


Massage Intake

Download & Print Massage Form

 


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



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