Synaptic Chiropractic Center 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 - Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Peripheral Neuropathy Application Form - (For peripheral neuropathy applicants only)
This application is for people suffering from peripheral neuropathy that wish to be considered as a candidate for our Neuropathy Program. It is truly an application process as Dr. Mexico only accepts neuropathy patients that he feels confident he can help after reviewing their application and performing a Neuropathy Severity Examination Score. Only after this processes has been completed will Dr. Mexico be able to let you know if your Neuropathy can be treated successfully with his program. You can print the form out and bring it in to our office during your scheduled consultation and examination.