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Online Forms

Acu-Chiropractic Wellness Center, PA 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.
  • Our fax number is: (651) 454-4375

New Patient Health History Forms

Patient Intake- If you are new to the office please print and fill out these forms a bring to your first visit. 

Pediatric Intake

Re-Examination Forms 

Updated Subjective Form

Neck Pain Oswestry

Low Back Pain Oswestry

Medica Forms/UHC

Required for a new injury or if you have a lapse of treatment over 30 days.

Subjective Complaint (just fill in bottom portion in page) 

Neck Pain Oswestry

Back Pain Oswesty

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