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114 S. Jackson Ave., Suite 200 Wylie, TX 75098
972-429-4677
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Southwestern Chiropractic and Wellness Center 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.

All of these forms need to be filled out completely.  If you have any questions, please feel free to contact our office.  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!

Patient Intake Form

HIPAA Agreements

Signature on File

Cancellation Policy

Chiropractic Insurance

If you are a patient under the age of 18, this form needs to be signed.

Consent to Treat Minor


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!

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