Online Forms

Back to Balance Chiropractic 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.

Please be advised that there will be one additional page of paperwork to be completed and signed regarding medical privacy laws. If you have any questions or concerns about the information presented in the paperwork, do not hesitate to give us a call at (559) 783-2225.

New Patient Health History Form - Required

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

Print Form

Pediatric Health History Form

This form is for children aged 0 to 5 years.

Print Form

Children's Health History Form

These forms are for children aged 6 to 11 years.

Print Form

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