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



Online 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 (2 and under), 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 below as well.

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. You may also scan the filled out paperwork and email them back to us ahead of time at

Adults:(Ages 3 and up)

New Patient Paperwork 2018

Fill out online with this link: New Patient Paperwork With Buttons


Pediatric Paperwork:(Ages 0-2)

Pediatric Chiropractic Forms


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. If you have been involved in an auto accident, please bring your car insurance ID card as well.

Accident Questionnaire