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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?

PDF IconDownload and Print Health History Form

Current Symptoms:

Neck Index: Please fill out this questionnaire regarding neck pain if you are experiencing neck pain:

PDF IconDownload and Print the Neck Index

Back Index: Please fill out this questionnaire if you are experiencing back pain:

PDF IconDownload and Print the Back Index

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

PDF IconDownload 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.

PDF IconDownload and Print the LEFS


Contact us today if you have any questions or are ready to schedule your first appointment.


English Chiropractic | (805) 964-9839