Thank you for considering Maxwell Family Chiropractic - A Wellness Way Affiliate for all of your health needs. Let's get started!
Please note these forms cannot be completed on mobile or tablet devices, as they are not compatible.
Step 1 - Complete the Health History Questionnaire. Once you have completed it, electronically sign and submit the form which will be downloaded directly into our secure server. Please note if the new patient is a child under the age of 10 you will need to complete the Pediatric Intake form instead.
Step 2 - Print out and complete the Signature Pages. Please bring them to your first appointment! If you forgot to bring them please alert the front desk and they will provide you with a new copy to complete.
Step 3 - Complete the Functional Assessment Questionnaire online. This will take approximately 30-40 minutes to complete. You will need to enter our Practitioner ID which is #91661929.
Financial information is availible here