New Patient Forms at
Oak Creek Relief & Wellness
Save time during your first visit
If you’d like to save time at your first appointment please print, fill out and bring the forms below related to your condition(s) with you.
STEP 1: Administrative Forms (required for chiropractic, Func. Med skip to Step 3)
Please print and complete the forms below. All five (5) forms below are required to be completed by all new patients.
STEP 2: Specific Clinical Forms (for chiropractic care)
Please print and complete the outcome assessment questionnaire(s) below that pertain to your current condition(s). ?*PLEASE NOTE if Right or Left if Form Below is Marked with Asterisk.
Head
- Headache
- Depression
- Dizziness
- Tinnitus
Upper Extremity
- TMD
- Arm*
- Arm/Hand*
- Arm/Shoulder/Hand**
- Elbow*
- Shoulder*
- Wrist*
Lower Extremity
- Lower Extremity**
- Leg/Foot*
- Hip*
- Knee*
*Please use the double asterisk forms if you have United Health Care*
STEP 3: Nutrition, Weight Loss and Additional Forms (required for Functional Med., optional for chiro)
Please print and complete the nutrition & metabolic questionnaire below if you would like to receive functional medicine, nutritional counseling, and/or weight loss services.
Adults
- Informed Consent For Functional Medicine and Nutrition
- Metabolic Assessment Form™
- Brain Function Assessment Form™ (BFAF)
- Brain Health and Nutrition Assessment Form™ (BHNAF)
- Neurotransmitter Assessment Form™ (NTAF)
Children
- Child Brain Health
