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Request An Appointment

701-364-2673

Core Health Chiro offers our practice member form(s) online so they can be completed it 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. All adult forms are not to be printed.  You may submit them online upon completion.


Adult Health History Form - Required (Adults 18 y.o.a. and older)

 

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!

No printing or downloading needed!  Click Here to access your initial paperwork online.

Your cooperation of completing the online forms prior to your initial consultation is greatly appreciated. 

We are honored to be on this health journey with you!

This lets us know the history and current state of your son/daughters health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

No printing or downloading needed!  Click Here to access your initial paperwork online.

ATTENTION:  Parents or Legal Guardians, Click Here to print out the Consent to Treat a Minor Form.  Please complete the paperwork before your initial appointment.

 


New Born, Infant, and Toddler Health History Form - Required (Infant to 5 y.o.a)


This lets us know the history and current state of your son/daughters health. 

What questions, concerns, goals, regarding wellness can we help you with? Let us know!

ATTENTION:  Parents or Legal Guardians!  The following forms should be printed out individually Form 1, Form 2, Form 3.  Please complete the papwork before  your child's inital appointment.

 


Wellness Center Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

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