Patient Intake Forms
For your convenience, 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!
*Download Instructions – Find the practitioner you are visiting below and click the button to download the intake form paperwork to your device.
Your Wellness Connection with Dr. Michelle Robin
Chiropractic
Wellness Patient
Pediatric
Counseling
Patient Privacy Practices
Ancient Wisdom Acupuncture and Wellness with Shamayne Tate
Acupuncture
Paperwork
Paperwork
Authentic Life
with Dr. Georgia Nab
with Dr. Georgia Nab
Functional Medicine
Female Intake Form
Female Intake Form
Functional Medicine
Male Intake Form
Male Intake Form
Chiropractic
Paperwork
Paperwork
Exodus Health
with Dr. Sean Cailteux
with Dr. Sean Cailteux
Chiropractic Paperwork
Healthy Life Chiropractic
with Dr. Shannon Pishny
with Dr. Shannon Pishny
Adult Forms
Pediatric Forms
Laura Ponce Acupuncture & Wellness with Laura Ponce
Acupuncture Paperwork
Khia Chiropractic
with Khia Simmons
with Khia Simmons
Chiropractic Paperwork
Practitioner Directory
For your convenience, we have put together the contact information of all the Practitioners for you to keep on hand.
PDF Handout
Recommendations
We put together many Health and Wellness Practitioners across various fields that we recommend.
