We Can Help You Achieve a Higher Quality of Life.
Because Quality of Life Means Everything!
Patient Application Form
WELCOME TO OUR CLINIC
We specialize in assisting our patient to achieve their highest level of health through our spinal and postural corrective programs. Our approach is very unique and advanced from other rehabilitative programs. This allows our patients to achieve far superior results compared to most other systems.
Please fill out the following information thoroughly AND DON’T FORGET TO CLICK THE SUBMIT BUTTON AT THE END.
This will allow the doctor to determine if you are a case we can accept. Please feel free to ask any questions if you need assistance. We look forward to serving you.
If you would like to learn more about becoming a new patient before submitting the form below, click here to learn about our New Patient Process
Otherwise if you have been directed to this page, please continue with the form below.
We are currently switching to electronic medical records in our office to go as paperless as possible! With our new program we have a new reminder feature that will require information from our patients and an authorization to either text or email you a confirmation of your appointment.