The purpose of our office is to restore and maintain the health of our patients through natural, chiropractic methods. Please complete this confidential health questionnaire fully and accurately. The more we know about the overall picture of your health, the better we will be able to help you. Doctors of Chiropractic are trained to detect and correct vertebral subluxations. Please respond to this questionnaire thoroughly, to help us determine potential causes and effects of subluxations in your case. If you have any questions, please don’t hesitate to ask our chiropractic assistant for guidance.
Please complete the PDF form. Download and save to your computer, fill out the form and then submit the form to Kohler Chiropractic via email.
You need Acrobat Reader to fill out the form, it is a free program. Available here: https://get.adobe.com/reader/
