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Welcome to Acu-Chiropractic Wellness Center, PA

/clients/1125/documents/2017_New_Patient_Paperwork.pdf

Acu-Chiropractic Wellness Center, PA offers our patient form(s) online so they can be completed in the convenience of your own home or 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.
  • Our fax number is: (651) 454-4375

New Patient Health History Forms

Online Intake- Please do on a computer (Mac or Windows). Certain smart phones are not compatible.

Patient Intake - To print if you don't have access to a computer or prefer paper.

​Pediatric Intake

Re-Examination Forms 

Updated Subjective Form

Neck Pain Oswestry

Low Back Pain Oswestry

Medica Forms/UHC

Required for a new injury or if you have a lapse of treatment over 30 days.

Subjective Complaint (just fill in bottom portion in page) 

Neck Pain Oswestry

Back Pain Oswesty




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Services
We strive to provide complete care for our patients. Learn more about all the services we provide.
Make An Appointment
We will do our best to accommodate your busy schedule. Schedule an appointment today!
Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.