What to expect on your first visit.

Dr. Laurie is very thorough with her patients.  Plan on the first visit taking approximately one hour.  Your first visit will consist of a thorough history, an exam, any necessary x-rays, and if needed, an adjustment.  Dr. Laurie will explain everything to you throughout your first visit.  If you have any questions during the visit, please feel free to ask.

Please fill out the new patient form below prior to your appointment so we can better understand your needs!

Name *
Name
Today's Date
Today's Date
Please pick one.
Address
Address
Phone Number *
Phone Number
Home
Phone
Phone
Cell/ Work
Gender *
Date of Birth *
Date of Birth
Medical
Pain & Irritation
Please place a check mark in the box for currently or previously experienced items.
Organ Systems
Please place a check mark in the box for currently or previously experienced items.
Special Senses
Please place a check mark in the box for currently or previously experienced items.
Other
Please place a check mark in the box for currently or previously experienced items.
Female Patients Only
Please place a check mark in the box for those items you are currently experiencing.
When did the major complaint first start?
When did the major complaint first start?
Have you had the major complaint before? *
If yes, when?
If yes, when?
Ex: 100, or 20
Does the major complaint affect other areas of the body? *
Have you lost work days?
Was the injury related to a work accident?
Was the injury related to an auto accident?
When did you last see a Chiropractor?
When did you last see a Chiropractor?
How do you want Nordic Chiropractic to handle your problems?
The Four Essentials Of Life - Food, Water, Oxygen, Nervous System Function
Do you smoke?
Are you currently doing anything to maximize your nervous system function?