Ajax Family Chiropractic offers our New Patient Initial Intake Form online so you can complete it in the convenience of your own home.
This information lets us know about you --- your reasons for attending our office as well as your health history and your current state of health.Adult Intake Form or Child Intake Form (12 & under)
Instructions: CLICK on appropriate form then:
1) OPEN IT, print and complete it , and email it back or bring it in with you to your first appointment
2) SAVE it, open it with Adobe Reader (makes it a fillable form), complete it, and send it back by email.
If you do not already have AdobeReader® , Download AdobeReader® (it's free).
Having completed form(s) will help us and save you some time at your first appointment.