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Maple City Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

NEW PATIENT PAPERWORK

NEW PATIENT HEALTH HISTORY

Please click on the link below to fill out your paper work and have it directly sent to our office.

Please bring a list of current medications with you. 

https://intake.mychirotouch.com/?clinic=MCC0018 

If you would rather print the paperwork and bring it with you, please follow this link.

https://intake.mychirotouch.com/BlankPDF/BasicPDF?clinic=MCC0018 


LOW BACK PAIN FORM- Required with Low Back Pain

This form gives us information on how your low back pain effects your daily activities of living. 

You may type in your information to the PDF and print. Or you may print and fill out by hand.

Download and Print Lower Back Pain Form


NECK PAIN FORM- Required with Neck Pain

This form gives us information on how your neck pain effects your daily activities of living.

You may type in your information to the PDF and print. Or you may print and fill out by hand.

Download and Print Neck Pain Form


Download the Free AdobeReader®