New Patient Health History Form


This form lets us know the history and current state of your health and what questions, concerns, and goals regarding wellness we can help you with.

Steps to complete the forms:

  1. Download and print the appropriate form below.

  2. Fill in the required information.

  3. Fax us your printed and completed form(s) or bring it with you to your appointment.

Tel: 810.659.2020 | Fax: 810.659.0310 | Email:

Paschket Chiropractic Clinic | 133 N Cherry St. Flushing, MI 48433

  • White Facebook Icon
  • White Twitter Icon
  • White LinkedIn Icon

© 2017 all rights reserved