Edmonton Chiropractor, Edmonton Alberta: Online Paperwork

Health History

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.

Health History and Future

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?
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Pain Diagram

This short form is used to show us what you're feeling and where. You’ve heard it said that a picture is worth a thousand words...
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Activities of Daily Living

Your situation may or may not be affecting the activities which you need to perform daily. Please use this form as a tool to jog your memory!
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Informed Consent

Before care can begin in our office, you will need to indicate that you understand some of the few risks associated with chiropractic care.
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Vehicular Accident Injury Form

If you were involved in an vehicular accident, we will need this form to be completed so that we can get a more full understanding of exactly what happened.
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Neck Disability Index

This form will give us the insight we need to understand your neck pain.
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Low Back Pain Index

Low-back pain is a complex situation that we can understand better as a result of these forms. Please complete both pages if you are experiencing low-back pain.
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Patients Who Are Children

If you are bringing your child with us, you will need to fill out the attached forms. The first pages will give us an idea about what is going on with your child; the last page will give us your official permission to help.
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