Poirier Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form
Pediatric Form 0-12 months
Infant & Baby Health Questionnaire (0 ‐ 12 mo)
Pediatric Form 13-36 months
Toddler Health Questionnaire (13‐36 mo)
Pediatric Forms 4-12 years old
Child Health Questionnaire (4 - 12 years)