The Colorado Springs Chiropractor to see - Chiropractor Colorado Springs

New Patient Forms

We offer our paperwork on line so you can complete it in the convenience of your own home.

General Health History Forms for
Dr. John Warner and Dr. Jerry Guevara.

Personal and Family Health History

This form lets us know what’s happened, but perhaps more important, where do you want to take your health?
 General New Patient Form

Metabolic Assessment

 Metabolic Assessment Form

Neurotransmitter Assessment

 NTAF - Neurotransmitter Assessment Form

Child Neuro Nutrition Questionnaire

 CNNQ Child Neuro Nutrition Questionnaire

Consent for Treatment and Insurance Information

 Consent for Treatment and Insurance Information

Notice of Information Practices

 Notice of Information Practices

General Health History Forms for
Dr. Gail Warner and Dr. Mary Beth Guevara.

Health History and Future

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?
 General New Patient Forms

Automobile Accident

If your health issue is the result of a car accident, we need some additional information.
 Auto Accidents Form

Worker’s Compensation

If your health issue is the effect of an injury at work, this information will help us help you.
 Workers Comp Form

Your privacy is important to us. All information received in the above forms and through other communications is subject to our Patient Privacy Policy.

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Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.