Accessibility View Close toolbar

Online Forms

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


Acupuncture New Patient Forms - Holly Johantgen-Brown, LAc, DOM, AP

New Patient Intake Form
Arbitration Agreement Form
Medical Release Form
Financial Policy Form
Prescription Form




Download the Free AdobeReader®

Location

Find us on the map

Office Hours

Our Regular Schedule

Monday:

9:00 am - 12:00 pm

2:30 pm - 6:00 pm

Tuesday:

7:30 am - 11:00 am

2:00 pm - 5:00 pm

Wednesday:

9:00 am - 12:00 pm

2:30 pm - 6:00 pm

Thursday:

7:30 am - 11:00 am

2:00 pm - 5:00 pm

Friday:

Closed

Closed

Saturday:

Closed

Closed

Sunday:

Closed

Closed

Testimonial

Reviews By Our Satisfied Patients

  • "The staff is incredible and I cannot say enough good things about the care, the staff, and the environment of this practice. They keep you well informed and updated on everything. I have suffered with pain for approximately ten years now and this is the first time I can see a light at the end of the tunnel. I have regained hope that I am not stuck for life in discomfort and the results of care have been tremendous. I cannot thank everyone at Holland chiropractic enough. You are all amazing!!!!!"
    Amanda M.