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Wells Family Chiropractic, PLLC offers our patient form(s) online so they can be completed it 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.

Adult Chiropractic Health Questionnaire

This paperwork will provide us with your health history and information on your condition.  Print and fill out this form prior to your visit so that you can save time when you come into our office.  Anyone above the age of 15 will be asked to fill out this form, however if under the age of 18 a parent or guardian does need to sign with the child.

Download and Print Form


Child Chiropractic Health Questionnaire

This paperwork will provide us with the health history and information of your childs condition.  Print and fill out this form prior to your visit so that you can save time when you come into our office.  Please note that this form is for any child 15 and under.  It does need to be filled out and signed by a parent or guardian.

Download and Print Form


Infant Chiropractic Health Questionnaire

This paperwork will provide us with the health history and information of your infants conditions.  Print and fill out this form prior to your visit so that you can save time when you come into our office.  Please not that this form is for infants from 0-24 months old.  It does need to be filled out and signed by a parent or guardian.

Download and Print Form


Pregnancy Chiropractic Health Questionnaire

This paperwork will provide us with your health history and information on your condition.  Print and fill out this form prior to your visit so that you can save time when you come into our office.  Anyone pregnant will be asked to fill out this form, however if under the age of 18 a parent or guardian does need to sign with the child.

Download and Print 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 office. You can print it out and bring it in to our office 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!

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