Online Forms

Wishaw Chiropractic Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

1. Health Questionnaire

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!

2. New Patient Consent to Examination Form

This form is to clarify that you grant the Chiropractor permission to carry out an examination of your spine during your initial consultation at the clinic. Please bring this form along with the Health Questionnaire.

3. GDPR Compliance and Privacy Notice Form

Under data protection law you, as a patient of Maple Clinics, have specific rights. To communicate these rights to you in a clear and concise manner, we are providing you with this privacy notice.