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Patient Forms

New Patient Information Form
If you've never been a patient at our office before, please complete this form. This let's us know the history and current state of your health, as well as your insurance information. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

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Child Consent Form
This authorizes the doctor to administer chiropractic care to a minor child under the age of 18 years.

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Auto Injury Questionnaire Form
If the reason you are coming in to see the doctor is the result of an auto accident, this form gives us the necessary information we need in order to send reports to your auto insurance compay. Along with this form, we will need the name, address, and telephone number of your auto insurance as well as your claim number.

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Work Comp Form
If the reason you are coming in to see the doctor is the result of an on the job injury and you are claiming workers compensation, this form gives us the necessary information we need in order to send reports to your employer and his worker's comp insurance carrier. BEFORE making this appointment make sure you have reported the injury to your employer and or supervisor and have WRITTEN authorization to come to our office.

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Contact Us

Hours of Operation

Monday:

7:30 AM-12:00 PM

2:00 PM-7:00 PM

Tuesday:

7:30 AM-1:00 PM

Wednesday:

7:30 AM-12:00 PM

2:00 PM-6:00 PM

Thursday:

Closed

Friday:

7:30 AM-12:00 PM

2:00 PM-5:00 PM

Saturday:

7:30 AM-11:00 AM

Sunday:

Closed

Our Location

279 W Capac Rd | Imlay City, MI 48444