Advanced Back & Wellness Center offers our patient forms online so they can be completed in the convenience of your own home or office.
- Click on the link and fill out our New Patient Intake Form
- Make sure to hit “Submit” when done
- Please call our office once you have finished to ensure we have received it
New Patient Health History Form- Required
- This intake does not work on Smart Phones
- Please fill out ALL questions
- The signature at the bottom must be filled out in order to submit
- If you experience any problems submitting the intake, please call us right away.
- The form MUST BE SUBMITTED, NOT PRINTED.
Thank you in advance. 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!