Infants and Toddlers. Ages: Birth to 5 years old.
Pediatric Infant and Toddler Paperwork
School Aged Children. Ages 6- 11 years old.
Pediatric School Aged Children Paperwork
Adults, Non-Pregnant. Ages 12 to 100+
Adult Paperwork
Pregnancy
Pregnancy Paperwork
Extensive History Form are for Fertility and Fatigue
PLEASE PRINT and Fill Out! Complete History Form
If using Insurance, Please fill out this Form
Insurance Form
HIPPA– Please Read!
Hippa
What our clients are saying...
"I sought chiropractic treatment from Dr. Fairchild after reading studies regarding adjustments helping with the success of IUI procedures and infertility struggles. My husband and I had tried conceiving for more than a year, and I wanted to take advantage of any benefit chiropractic adjustments could offer. Dr. Fairchild was extremely knowledgeable on the topic and made me feel at ease immediately - much needed during such a stressful time! I, my husband, and our new baby are so happy to have found Pea and the Pod Chiropractic!"
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