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...
"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 there. My midwife had suggested for me to seek assistance from a chiropractor. After searching around online, I stumbled upon Dr. Brenda Fairchild, who to my surprise specialized in exactly what I was working for! At the end of my first appointment with Dr. Brenda, I knew I made the right choice. After visiting with her I knew that she genuinely cared about me and my baby. She gave me her personal contact information so I could contact her anytime the day or night. After three appointments with Dr. Brenda in my 37th week, she had successfully flipped my stubborn baby into the head down position. I continued to see her throughout my 40th week just to make sure he stayed down, which he did. My delivery was completely different[from first] and I contribute that to the sessions I had with Dr. Brenda. My labor was a breeze!! My contractions were manageable. I pushed for about two contractions until little Bryson was born. Honestly it was painless! I didn't have any burning or tearing when I delivered him. I cannot say enough great things about Dr. Brenda!"
Send us an Email
