Initial Intake Forms (online)

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.


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Office Hours

Our Regular Schedule

Ajax Office


7:45 am-11:00 am

3:00 pm-7:00 pm


7:45 am-12:30 pm

3:00 pm-6:00 pm


7:45 am-11:00 am

3:00 pm-7:00 pm


7:45 am-12:30 pm

3:00 pm-7:00 pm




9:00 am-12:00 pm




Reviews By Our Satisfied Patients

  • "Dr. Mark and Dr. Mike are both dedicated doctors who go out of their way for their patients, and are constantly striving to provide the best care possible. Highly recommended!"
    Byron M.
  • "I've known Dr. Mark and Dr. Mike for more than a decade now. I have always been so impressed by them and their commitment to the people they serve. They are truly gifted Doctors and healers! Thanks Dr. Mike and Dr. Mark for all you do for me and so many others!"
    Mark F.