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Online Forms

We offer our paperwork online so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.


Welcome to the Puritz Chiropractic Center Health Questionaire

This lets us know more about you, what’s happened, and perhaps more important, where do you want to take your health? All new patients need to fill out this form.

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Back Index-ACN

This form gives us specific information on how your back and associated pain, is affecting your activities of daily living. This form shall be filled out by new patients as directed by the office.

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Neck Index-ACN

This form gives us specific information on how your neck and associated pain, is affecting your activities of daily living. This form shall be filled out by new patients as directed by the office.

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Free AdobeReader®

Get adobe readerEach form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Call our Westminster chiropractic office to get started with chiropractic care today!


New Patient Forms | Puritz Chiropractic Center