ADDRESS

1146 Blairs Ferry RD NE, #5
Cedar Rapids, IA 52402

PHONE

319-393-4303

Online Forms

NEW PATIENT FORMS

If you are new to the office, please download, print, and complete the new patient forms found on this page and bring them to your first appointment. This will save you 15-20 minutes in the office. If you are unable to print the forms, we also have them available at the front desk. If the appointment is for a child (under 13), please fill out the forms labeled “Pediatric Intake Paperwork.” Each patient or their guardian must also fill out the HIPPA form.  Please fill out the forms completely and as accurately as possible.

If this is for a work injury or auto accident, please also fill out the additional accident form.

If you do not already have Adobe Reader® installed on your computer, Click Here to download.

Click on the links below, which will download the paperwork as a PDF file.

Adults:

New Patient Forms

HIPPA & CONSENT

Children:

Pediatric Chiropractic Forms

HIPPA & CONSENT

Auto Accident or Work Injury

If you have been involved in a car accident or work injury, please bring in the additional form listed below, as well as the normal adult paperwork listed above.

Accident Questionnaire