An adult human spine typically consists of 26 moveable segments: seven cervical vertebras, twelve thoracic vertebras, five lumbar vertebras, one sacrum, and one coccyx (tailbone). Intervertebral d ...View Article
You are using an outdated browser. Please upgrade your browser to improve your experience.
Reynolds Chiropractic offers Online Patient Intake Forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Patient Sign-In - Required
This is where you will place a red dot on your biggest problem area first and answer all the questions in the box. This you will place another dot in your next problem area and answer the questions for that specific complaint as well. You can add as many dots as you would like, but you can also add more later. We really need to know about your top 2 or 3 complaints.
Patient Information - Required
This is just your general information
Insurance - Not required,
but would be nice. We can fill this in for you when we make a copy of your insurance card.
Accident - Required if you were in an accident
This is a long form as well
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