The Goleta Chiropractor to see - Chiropractor Goleta

Online Paperwork

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.



Health History Questionnaire:

This lets us know what has happened, but perhaps more important, where do you want to take your health?
 Download and Print Health History Form

Current Symptoms:

Neck Index:  Please fill out this questionnaire regarding neck pain if you are experiencing neck pain:
  Download and Print the Neck Index

Back Index:  Please fill out this questionnaire if you are experiencing back pain:
  Download and Print the Back Index

Arm/Shoulder/Elbow/Wrist: Please fill out if you are experiencing pain in the arm, shoulder or hand:

Download and print the DASH questionnaire

Lower Extremity Functional Survey: Please fill out if you are experiencing pain in the hip, leg, knee, ankle, or foot.

Download and Print the LEFS



Free AdobeReader®

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.

Call now to learn more about chiropractic care!



Dr. Kevin English, 5370 Hollister Ave, Suite I, Goleta, CA | (805) 964-9839
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Dr. Kevin Asks some important questions of interest to Goleta residents - Chiropractor Goleta Dr. Kevin Asks...

Can someone who has had back surgery receive chiropractic care?
Yes. Rest assured that we will avoid the surgically modified areas of your spine. However, what we find is that surgical interventions will often produce spinal instability above or below the involved level. This is will be the focus of your chiropractic care.
Why does chiropractic work?
Chiropractic works because your nervous system, consisting of your brain, spinal cord and all the nerves of your body, controls and regulates every cell, tissue, organ and system of your body. A chiropractor locates and reduces areas of nervous system compromise (usually along the spine) so your capacity to heal is restored. Chiropractic works by helping your body work as it was designed.

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