If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Follow Us

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




Download the Free AdobeReader®