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Holland Chiropractic Wellness Center 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.

New Patient Intake/Health History/HIPAA & Privacy Forms - Required

This lets us know the history and current state of your health. What questions, concerns, and/or goals regarding wellness can we help you with? Let us know!

Download & Print Form


Pediatric New Patient Intake/Health History/HIPAA & Privacy Forms - Required for children 10 and under

Download & Print Form


Acupuncture New Patient Forms - Holly Johantgen-Brown, LAc, DOM, AP

New Patient Intake Form
Arbitration Agreement Form
Medical Release Form
Financial Policy Form
Prescription Form




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