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Northern Chiropractic offers our patient form(s) online so they can be completed it 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.

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

New Patient Health History Form - Required

Download & Print Chiropractic Form

Pain Scale Assessments - Optional

Download & Print Neck Disability Index Form

Download & Print Oswestry Low Back Pain Scale Form

Download & Print LEFS Lower Extremity

Download & Print QuickDash Upper Extremity

Massage Intake - Optional

Download & Print Massage Form

HIPPA - Optional

Download & Print HIPPA Privacy Policy

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Registration Form

Download the Free AdobeReader®

Sign-up using the form or call us at 907-696-4878 to make your appointment today!

THIS ---->https://northernchiropractic.com/new-patient-center/online-forms.html

Office Hours

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
7:00am 8:00am 7:00am 8:00am Closed Closed Closed
5:00pm 6:00pm 5:00pm 6:00pm


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