Subscribe to our Newsletter Facebook Twitter LinkedIn Google Plus Instagram book appointment BOOK APPOINTMENT

Call us today: 519.827.0040

About Us How We Can Help Products Blog Forms Contact Us
gold arrow
  gold arrow
gold arrow
Massage Therapy
gold arrow
Laser Therapy
gold arrow
Naturopathic Medicine
gold arrow
Shockwave Therapy
gold arrow
gold arrow
Custom Orthotics
Family Silhouette

Chiropractic New Patient Paperwork


If you are a new chiropractic patient to our clinic, you are required to complete the age appropriate Chiropractic Intake Forms prior to your initial visit. Please print and complete by clicking on the appropriate link below. The Consent Form also needs to be printed and reviewed, but please DO NOT complete this form until you attend your visit, as consent needs to be signed in the presence of your Doctor. Please bring your completed forms to your initial visit. These forms may also be filled out electronically and emailed back to us at if you do not have access to a printer.

Adult Chiropractic Intake Forms - age 7 & up
Pediatric Chiropractic Intake Forms - age 6 & under
Consent Form

If you have been involved in a Motor Vehicle Accident, please click here for the necessary MVA paperwork


If you have been involved in a Workplace Accident, please click here for the necessary WSIB paperwork

Norfolk Blog



Feb 2018

Practitioner Profile - Andrea Ruiter, RMT

by Marnie Kerr

Our profile series continues with Andrea Ruiter, RMT. Here are 5 things you probably don't know about Andrea! Read More >>


Jan 2018

Practitioner Profile - Dr. Tim Lodder

by Marnie Kerr

Our Practitioner Blog Series continues with a profile of Dr. Tim Lodder DC. Here are his answers to his "top 5" questionaire. Read More >>


Show All Posts