Holland Chiropractic Wellness Center offers our patient form(s) online so they can be completed 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.

New Patient Intake/Health History/HIPAA & Privacy Forms – Required

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

Download & Print Form

Pediatric New Patient Intake/Health History/HIPAA & Privacy Forms – Required for children 10 and under

Download & Print Form

New Patient Intake – SoftWave Therapy

Download & Print Form