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Online Forms

Family Chiropractic at Northwest Wellness Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office. We have separate forms for you based on if you plan to pay in cash or use your insurance, if you have been in an automobile accident, or if you are on a workers compensation injury. Please download the appropriate form.

  • 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.


Cash or Insurance for Adults

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!

/storage/app/media/Ins_and_TOS_intake.pdf

Cash or Insurance for Children

Children Forms are for patients 13 years old and under. Thank you!

Download & Print Form


Automobile Accident

Download & Print Form


Workers Compensation

Dowload & Print Form



Download the Free AdobeReader®

 


 

Location

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Office Hours

Our Regular Schedule

Monday:

7:00 AM

7:00 PM

Tuesday:

8:00 AM

7:00 PM

Wednesday:

7:00 AM

7:00 PM

Thursday:

8:00 AM

7:00 PM

Friday:

7:00 AM

5:00 PM

Saturday:

9:00 am

12:00 pm

Sunday:

Closed

Closed

Testimonial

Reviews By Our Satisfied Patients

  • "I have only been to a chiropractor once in my life so moving to a new plan and having to find one was scary . Also my roommate hurt her back and she had never been to one . So we went here and the professional friendly environment was wonderful. I already feel better after one visit and I feel excited about continuing to improve my health and encouraged. I highly recommend these Dr’s and facility.
    LuAnn Hood"
    LuaAnn Elesky H.
  • "Dr. Emmert and everyone at Family Chiropractic is so good about meeting you where you are to address your chiropractic needs. I’ve had a very hectic schedule of late and they have consistently worked with me to make sure I receive care. Excellent folks!"
    Sophie G.