Bender Chiropractic Health & Vitality Center offers our patient form(s) online so they can be completed it in the convenience of your own home or 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.
New Patient — Nutrition
Download and Print New Patient Introduction Form
Download and Print Systems Survey Form
Download and Print Toxicity Questionnaire
Download and Print 7 Pillars of Health Survey of Body's System
Download and Print Adrenal Fatigue Quick Check
Download and Print 5 Brain Systems Checklist
Download and Print Stress Assess Questionnaire
Click here to take an online Wellness Check Questionnaire. PRINT RESULTS WHEN DONE