New Patient Forms
Personal History Form
When filling out the Personal History, you will be asked about physical, chemical, and emotional stressors that go as far back as the womb. We believe that whatever goes to the back of your mind goes into the spine, and that the position, tone, and tension of your spine is determined by the past and present stresses in your life and how well you have adapted to these stresses. Stresses in your life may affect the health of your spine and nervous system. The good news is that when your spine changes, your life changes, and on your first visit you will have an opportunity for a happier and healthier spine and life. Call (808) 828-0418 to book your New Patient Visit and the “Personal History” form, will be sent to you to fill out, and the Doctor of Chiropractic will go over it with you on your initial visit.
Document to Read:
Please read the following. You will be asked to sign that you have read, understood and agree to the following before seeing the Doctor of Chiropractic. If you booked by phone or in the office or you inquired about our services online, you will be asked to sign that you have read, understood and agree to the following before seeing the Doctor of Chiropractic.
Click here to read prior to your first visit:
Informed Consent to Receive Network Spinal Analysis Care
Special Notice for Medicare and Insurance Patients
COVID-19 Protocol
Notice of Privacy Practices
Current or Returning Patient Forms:
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