Patient Forms

Advanced Chiropractic Back & Neck Pain Center offers our patient form(s) online so you can complete 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 and fill out the required information.
• Fax us your printed and completed form(s) to 952-835-3895 or bring it with you to your appointment.

New Patient Health History Form - Required

This will let us know the history and current state of your health. What questions, concerns, and goals do you have regarding wellness? Please let us know!

Auto Accident Form

Download & Print Form

Worker's Compensation

Download & Print Form

Member Wellness Registration Form - Optional

This form is necessary to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep updated on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!