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Welcome

If this is your first visit or you are receiving a new form of care, please fill out and submit this form so that we may best serve you.  Thank You!
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    Please select which type of care you are seeking
    • Pediatric Chiropractic
    • Chiropractic
    • Mercier Therapy
    • Both Chiropractic + Mercier Therapy
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    If YES, please describe
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    • Natural Conception
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    Answer YES if you have a history of pelvic pain
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    (ie. location, intensity, sensation, how it affects your daily activities and quality of life)
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    (ie. Type of testing, imaging, etc.)
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    • Yes, no abnormalities
    • Yes, abnormalities found
    • Have not had an ultrasound
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    • Yes
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    Thank you for taking the time to answer the questions regarding your upcoming Mercier Therapy appointment. During your visit the doctor will discuss your history with you, evaluate your general pelvic movement and check the position and mobility of your uterus and ovaries. From there, a plan for further care will be made if you are a candidate for Mercier Therapy.

    We look forward to serving you!

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    Slide to describe how you are feeling today
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    Thank you for taking the time to let us understand more about you, see you soon!

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