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!

Client-Forms

*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

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Chiropractic Paperwork

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Wellness Patient Paperwork

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Pediatric Paperwork

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Patient Privacy Practices

Authentic Life
with Dr. Georgia Nab

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Female Intake Form

Male Intake Form

Ancient Wisdom Acupuncture and Wellness with Shamayne Tate

pdf-download

Acupuncture Paperwork

Arvan Integrative Health Care
with Dr. Andrea Arvan

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Adult Paperwork

Complete Chiropractic & Wellness
with Dr. Kate LaVigne

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Chiropractic Paperwork

Exodus Health
with Dr. Sean Cailteux

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Chiropractic Paperwork

Laura Ponce
Acupunture & Wellness

pdf-download

Acupuncture Paperwork

Healthy Life Chiropractic
with Dr. Shannon Pishny

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Adult Forms

Pediatric Forms

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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PDF Handout

Recommendations

We have put together the contact info for the many Health and Wellness Practitioners across various fields that we recommend.

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PDF Handout