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For your convenience, our intake forms are available online to print.

Please fill out all forms legibly in ink. Completed forms may be faxed or scanned and emailed to us prior to your first appointment, or you may bring them with you to your appointment. Our fax number is 913-962-7416. We request new clients arrive 10 minutes prior to their scheduled appointment time.

If you choose not to download forms and instead complete them at the center, please arrive 30 minutes prior to your scheduled appointment time. Please call us at (913) 962-7408 if you have questions regarding completion of forms.

Thank you for trusting us to care for your wellness!

Your Wellness Connection

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Chiropractic
Patient Forms

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Acupuncture
Patient Forms

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Wellness
Patient Forms

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Pediatric
Patient Forms

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Notice of Patient Privacy Practices

Vitality Chiropractic and Family Wellness, LLC with Dr. Stacy Jimenez

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Adult
Paperwork

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Pediatric Paperwork
(10 and under)

Healthy Life Chiropractic with Dr. Shannon Pishny

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Adult
Paperwork

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Pediatric Paperwork
(10 and under)

WELLNESS RESOURCES

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PRACTITIONER DIRECTORY
For your convenience, we have put together the contact information of all the Practitioners for you to keep on hand.

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RECOMMENDED HEALTH AND WELLNESS PRACTITIONERS
For your convenience, we have put together the contact information for the many Health and Wellness Practitioners across various fields that Dr. Robin recommends to many of her clients and friends.

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NOTE: You will need Adobe Acrobat Reader installed on your computer to view these documents. If you do not have Acrobat Reader installed, you can click on the image to the left to download it.

Contact Us

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