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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.

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 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! 

new-patient-forms.doc     no-surprises-act.docx    functional-rating-index-1-page.pdf


Pediatric Form - Required

This form is for children aged 0 to 5 years.

pediatric-forms-0-5-yrs.doc    functional-rating-index-1-page.pdf   no-surprises-act.docx   minor-consent-form.doc


Children's Form - Required

These forms are for children aged 6 to 11 years.

children-6-11.doc     no-surprises-act.docx    functional-rating-index-1-page.pdf


Reactivation Form - Required

These forms are for established patients, that have not been under care in over 90 days.

reactivation-form-1.doc     no-surprises-act.docx    functional-rating-index-1-page.pdf   minor-consent-form.doc 


AHS Form- 

ash-patient-progress.pdf     functional-rating-index-1-page.pdf



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CONTACT US TODAY

We look forward to hearing from you

Office Hours

Our Regular Schedule

Back to Balance Chiropractic

Monday:

8:30 am-5:00 pm

Tuesday:

1:00 pm-5:00 pm

Wednesday:

8:30 am-5:00 pm

Thursday:

1:00 pm-5:00 pm

Friday:

8:30 am-12:00 pm

Saturday:

Closed

Sunday:

Closed

Locations

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Testimonials

Reviews By Our Satisfied Patients

  • "After having had chiropractic adjustments for 60 years, I feel Dr. Bush was heaven sent to me. I am amazed at the fast results I have made in a short time. I am so much better that I now feel like I am back among the living."
    Betty P.
  • "After several months of seeing Dr. Bush and feeling much better, I asked if I could check my weight I was so astonished that the scales revealed a 1 lb difference of distribution of my weight."
    Bob O.
  • "Dr. Bush has helped me so much and I recommend her to everyone I talk to with any of the symptoms I had."
    Margaret C.
  • "I crawl in, walk out! Don't think I could function without her! Great staff too!"
    Roxy M.
  • "Quality care."
    Amber R.
  • "Chiropractic care helps keep my body in alignment & pain-free."
    Angela B.
  • "Awesome office staff! Dr. Bush is phenomenal- really treats your overall well being!"
    Vikki C.
  • "Very compassionate to me when I am in pain. Very helpful and answers my questions."
    Beverly F.

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