Intake Forms

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 for Fertility and Fatigue
Please print and fill out.
Complete History Form

Insurance
If using Insurance, please print and fill out.
Insurance Form

HIPAA
Please Read.
Hipaa

What our clients are saying…

I can’t say enough good things about Dr. Brenda. She’s amazing, and truly cares about her clients. I went to her when I was pregnant, and now take my oldest child there for her chiropractic needs. I recommend her to all of my friends. Traci W.

“I just wanted to give a big thank you to Dr. Brenda and Kristyn at Pea and the Pod Chiropractic.  You have made such a big difference in the lives of my two little ones.  Both of them having silent reflux had been miserable.  Since they have been seeing Dr. Brenda, the improvement has been…

Dr. Brenda is an actual real life super hero. She is gentle, caring and full of knowledge. Whenever I have an issue pop up, she surprises me with information on how all the things I’ve had going on correlate with one another. She is the absolute bees-knees.

“Dr. Brenda and her staff is absolutely wonderful! I started therapy at 30 weeks pregnant because my baby was breech. After 2 sessions my baby flipped and now at 36 weeks he is still head down thank goodness! I always bring my 22 moth old and Dr. Brenda is so great at having entertaining toys…

“Dr. Brenda and the staff at Pea and the Pod are amazing.  They make you feel comfortable like you are part of the family.  They are great with my infant and preschooler.  The only doctor my son enjoys going to see every month.  I feel great when I leave and my kid’s colds have been…

“I came to see Dr. Fairchild with severe back pain and sciatic pain. At 33 weeks pregnant I was not able to stand or walk for long periods of time. A basic grocery shopping run would cause me to rest all day. At 39 weeks I feel great. No more sciatic pain. My back feels…

I’ve been to many chiropractors in my life. None of them spent as much time with me as Dr. Brenda did nor did they do the necessary muscle work I needed. She’s kind and patient and also had my extremely hyperactive son who is on the spectrum puddy in her hands. I consider this quite…

She is extremely informative with everything pregnancy. I drive about an hour to see her, and she is well worth it. Visiting Pea and the Pod Chiropractic is going to remain a regular part of my health regimen. Taylor N.

Well done doc. I’m pregnant! 😁

“Dr. Brenda Fairchild started seeing me while I was 9 months pregnant to help my baby turn from the breech position. Although her position was due to circumstances out of my control, Dr. Brenda’s care was exceptional. She saw me multiple times a week and gave me the best care. In the long run, I…

“All I can say is Dr. Brenda has seen me through some of the biggest events in my life.  When I first came to Dr. Brenda in October, 2011 I was having pain in my entire back from working in retail.  On my first visit we discussed other concerns and I had mentioned that I…

“My family had a great experience visiting Dr. Brenda. It is worth the two hour trip! I have been seen along with my mother and my two children to improve our wellness. Her care is very gentle and very child friendly. Dr. Brenda also provides a wealth of information for the topics I am interested…

Dr. Fairchild is great. She provides a relaxing environment and makes you feel comfortable. She explains everything she’s doing before hand. I highly recommend her! Stella L.

“Dr. Brenda has worked as my chiro for a while now and I could not be happier. I love being able to go in and tell her exactly what’s going on and she sympathizes and knows exactly what to do. I also get the full experience with her by getting diet and exercise suggestions which…

“I cannot say enough about Dr. Brenda! I first met her at a County Chamber event where I learned about her specialties in chiropractic care. My husband and I had tried for several years to get pregnant. Six months after a loss we decided to see a reproductive specialist. After many tests, I ended up…

Love Dr. Brenda!! She’s a miracle worker and has helped my infant son immensely! I recommend her to everyone. Darci O.

“I was having horrible lower back pain so a friend referred me to Dr. Brenda. Within a few visits I was able to get through the day with almost no pain and after a month, I feel fantastic! Dr. Brenda is always cheerful and I look forward to my appointments.”

“Once I became pregnant in November, 2011 we started to focus on keeping my pelvis from rotating and keeping my back aligned and strong during my pregnancy.  Dr. Brenda recommended exercises I could do during the different trimesters to keep my back and abdominals strong for support but also to keep everything stretched for delivery. …

Dr. Brenda helped our 20 month old daughter with an issue we had been struggling with since birth. We can’t thank her enough for the time and care she has given us all!  Meghan C.

I’m so happy we found a family chiropractor. Pea and the pod for life!!!!!! Veronika P.

I love this practice!! It is refreshing to have a medical professional actually take time to listen and work with me to find the source of medical issues I’ve struggled with for years. Thanks, Dr. Brenda, and everyone in your office, for being so great at what you do – helping people live healthy lives!!…

“I visited Dr. Fairchild for constant pain in my lower back and within just a few visits was feeling significantly better! Her gentle nature, thorough attention, and ability to listen to her patients about their pain and injuries is what makes her an outstanding healer! I have and will continue to recommend her services to…

I was seeing Dr. Brenda once a week this summer and she was helping me prepare for the birth of baby #2. I was hoping to avoid an induction or a c-section. Well everything turned out great! I woke to spontaneous labor pains around midnight on August 19th. I was at the hospital by 2:30 a.m. and had the baby…

Way beyond impressed. Words can’t even describe! Very knowledgeable, friendly, helpful and ready to help in any and every way! I would have been out of work (not getting paid) due to pain if not for her! She definitely has my highest recommendation!!!!

“I can’t say enough about how much we love Pea and the Pod Chiropractic!  From start to finish, each visit is an enjoyable experience that the kids eagerly anticipate.  Kristyn in the front desk is so friendly that my kids love to chat with her while they wait their turn.   Dr. Brenda is incredibly patient…

“What an amazing place to visit! I recently started going to Pea and the Pod as it was recommended to me by a friend. I was suffering from migraines for a YEAR! I have been to the office a few times for massage and an adjustment. My migraines have just about vanished! I am so…

Dr. Brenda is amazing with helping any and all issues. She has helped with my chronic back pain as well as done checks on my overall health to figure what other things I’m dealing with. She really is a totally made for what she does and is so patient and kind! – Gabrielle F.

“Although I had been skeptical of chiropractors, the care I received at Pea and the Pod was excellent and the relief of my lower back pain was swift. Dr. Brenda and the staff are warm and friendly and I felt that I was in good hands.”

“At 18 weeks pregnant, I began experiencing sciatic nerve pain. Having previously experienced this in my last pregnancy, I thought I would just have to tough it out until delivery. After several weeks of pain, I mentioned it to my midwife and she recommended seeing a Webster Certified chiropractor. My search for a provider led…

Dr. Brenda is the best of the best! She truly cares about each one of her patients, gives out her cell number for questions and even mails cards when special things happen in your life. She worked miracles on me while pregnant and postpartum and has worked with my infant as well and healed her…

“We can’t thank you enough for treating Ian’s torticollis. It’s a disconcerting thing to face when your infant has any issue, but your reassurance and capable touch has made this far easier to manage. His physical therapist is amazed by Ian’s transformation – from a 20% tilt to almost midline in only 4 weeks! –…

I’ve been going to Pea and a Pod now for almost two months and I LOVE it! In my first pregnancy, I went to just a plain old chiropractor that didn’t specialize in pregnancy, and had a so and so experience. I wish I would’ve known about this practice sooner! Dr. Brenda Fairchild is an…

“I have been coming to Pea and the Pod for a couple of months now, and have felt a tremendous improvement in my back pain. The office staff is wonderful, and Dr. Brenda is one of the nicest, most caring doctors you will ever meet. She will go out of her way and take the…

I went to her office because of a breach baby at 36-37 weeks and she took the time we needed to help my baby get in to the correct position. She explained everything she was doing and made me feel confident in the treatment and after visits twice a week my baby turned at 40…

I really can’t thank Dr. Brenda enough for her care and knowledge. She is absolutely amazing! Melissa S.

Dr. Brenda is AMAZING!! I am a mother of three who struggles with endometriosis pain and most recently a horribly uncomfortable sciatic nerve. For the past two months I have been so uncomfortable no matter what I do I have been unable to get relief nor have I been able to sleep. Yesterday I had…

Today I had my 1st visit to Pea and the Pod Chiropractic office! Dr. Brenda was very gentle with my body and took time to answer all of my questions and care for my needs!! My body feels amazing and my energy is up! I can’t wait to visit her office again for another prenatal…

“My family has known Dr. Brenda for almost 2 years now. […] I came in often those last few months before I had Christina and each time we were greeted with a smile and treated like friends or family. Christina has been a patient of Dr. Brenda since the day after she was born. She…

“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…

“I have been to a few other practices in the area, and left because I felt like I was just a number, quickly adjusted and shoved out the door. Dr. Brenda and her staff don’t make you feel like that at all! A very warm and inviting practice that makes you feel extremely cared for.…

Thank you so much for helping me go into labor. I got the natural vbac I had been praying for. We were only at the hospital for 20 minutes and I had him. 🙂 From the time my contractions picked up in intensity and were regular, it was 4 hours of labor, 3 pushes, and…

“Dr. Brenda was recommended to me by my midwife to try to get my baby in an optimal birth position. It worked wonders, my first two babies were born posterior and this one was in perfect position! My visits were always positive and comfortable. Dr. Brenda really listens and has a very gentle way when…

Highly recommend Pea and the Pod Chiropractic. love love love this place! – Jae F.

“A successful all natural water birth of a healthy little boy at The Birth Center was my ultimate goal during my pregnancy in December. At 37 weeks I was told my baby was breech and unless I figured out a way to get him to flip into position, I would not be able to deliver…

Happy cannot possibly describe how I feel about this practice, ecstatic would be a better term! Not only have I been impressed by the consummate professionalism I have encountered, but this practice also infuses warmth with the treatment of their patients! Which many doctors in the Delaware area most noticeably lack… I had been battling…

“I am very happy with the personal and caring atmosphere. Treatment is going well and I am feeling better with each visit. I would highly recommend your office to others!”

Kristyn, you are sooo awesome. I know this part of your job must really stink. Thank you for doing this. You go over and beyond…and I see that. Dr. Brenda is lucky to have you. Megan H.

I pulled my lower back out Weds night. All day yesterday I was in some serious pain. I prayed and relaxed all day, Thursday. I was so scared because I had a wedding today, and I knew I couldn’t be immobile! My lovely chiropractor, Dr. Brenda got me in this morning at 7am. She fixed…

“I can’t begin to explain how fortunate my family is to have found Dr. Brenda and her practice. My children have suffered from allergies, asthma, ear infections and various digestive issues and were on a multitude of medication.  If that wasn’t enough our youngest son was diagnosed with Juvenile Rheumatoid Arthritis. I was in search…

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302.455.PEAS (7327)

708 Ash Blvd, Middletown, DE 19709

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