Online Forms

Itasca Health and Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Print Welcome Form

Print Health Profile

Print Pain Chart

Print Quadruple VAS

Print Low Back Pain Questionnaire

Print Neck Pain Questionnaire 

Print DASH Form (arm-shoulder-hand)

Print Knee Questionnaire

Print Shoulder Questionnaire

Print Lower Extremity Functional Scale

HIPPA Privacy Practices



Download the Free AdobeReader®

Location

Find us on the map

Office Hours

Itasca Health & Chiropractic

Monday

1:00 pm - 7:00 pm

Tuesday

3:00 pm - 7:00 pm

Wednesday

9:00 am - 7:00 pm

Thursday

3:00 pm - 7:00 pm

Friday

9:00 am - 1:00 pm

Saturday

By Appointment Only

Sunday

Closed

Itasca Health & Chiropractic

Monday
1:00 pm - 7:00 pm
Tuesday
3:00 pm - 7:00 pm
Wednesday
9:00 am - 7:00 pm
Thursday
3:00 pm - 7:00 pm
Friday
9:00 am - 1:00 pm
Saturday
By Appointment Only
Sunday
Closed