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...
"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 me to Dr. Brenda. I had my first visit with her when I was 30 weeks pregnant. After two visits my pain had improved tremendously and was essentially gone. I continued seeing her to make sure my alignment was maintained and the baby (previously breech) stayed in a good position. At 36 weeks though, he had other ideas and turned frank breech again. I saw Dr. Brenda that night and throughout the weekend and was able to avoid an external version scheduled for the following Tuesday (4 days after finding out he was breech again). The baby stayed Vertex from that point forward and all is well. Thank you Dr. Brenda for taking such good care of our new baby boy and me."
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