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Laurel Street Chiropractic & Spa 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 clinic.  Please take a few moments to fill them out and then you can either print them to bring with you, or fax them to us prior to your appointment.  Our fax # is 907-258-6610.

  • 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.

New Patient Intake Form - Required

This gives us all the necessary information required to set up your account.  If you have insurance coverage, please be sure to fill in your subscriber information where indicated.

Download & Print Form


New Patient Health History Form - Required

This form tells us all about your current condition.  Please be as descriptive as possible so that we are able to determine what the best course of treatment will be.  If you have any questions, please ask!

Download & Print Form


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



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