To download and print your initial visit forms, please click here Please complete all questions on the form in blue or black pen These are completed prior to your first visit only Please do so neatly and legibly Please do not fold your forms Incomplete forms will not be accepted Remember to make an appointment before you come in
Important These forms will ask for all current or past health conditions. These facts must be known if we are to provide the safest and most appropriate treatment. Some may initially feel our forms are needlessly thorough. They are of the depth recommended by the Canadian Chiropractic Association to enable the practitioner to provide the most appropriate care possible. We take the extra effort to protect your health. Please answer all questions truthfully and completely. Please list all medications and all previous accidents, injuries, surgeries or illnesses where indicated. Not doing so may cause a delay during the interviewing process. Your First Visit Your first visit has 3 parts, each about 10-15 minutes: Filling out forms (may be done at home) Initial Interview and Examination Initial Treatment and recommendations
Because of the filling out of forms, you are scheduled to be visited 15 minutes after your arrival time. Ideally it is best to let us know in advance if you are filling out your forms at home, so we may schedule accordingly. We do not double book, and we seldom run behind schedule. Why Ask About... Why ask about surgeries: Spinal surgeries for obvious reasons Abdominal surgeries may result in abdominal scar tissue and weakness We may need to avoid areas where surgeries have been performed It may make us aware of other diseases and risk factors
Why ask about past diseases Visceral diseases often cause back pain or circulation problems Cardiovascular disease may place you at higher risk with some of our treatments Cardiovascular disease will change our exercise prescription Respiratory disease may cause back pain, and coughing may cause injury Gastrointestinal disease may change nutritional advice, may cause low back pain Genitourinary dysfunction may be a sign of low-back nerve damage
Why ask about alcohol use Why ask about medication Medication may interfere with some supplements Medications give an idea of your general health Side effects of medications may place you at higher risk with some of our treatments
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Initial Visit Forms