Online Forms

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.
  • We also have the option of filling it all online.  Click Here and it will take you to the website to fill out our paperwork. 
  • Fax us your printed and completed form(s) or bring it with you to your appointment.
  • To hold your new patient appointment, we do require a small reservation fee.  The fee is refundable if appointment is moved or cancelled 24 hours prior to the 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

HIPAA Release of Information

Signature on File

Cancellation Policy

Chiropractic Insurance

EHR Intake Form

Text Authorization

Informed Consent

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

Consent to Treat Minor

Download the Free AdobeReader®


We look forward to hearing from you


Find us on the map

Office Hours

Our Regular Schedule

Wylie Office


9:00 am-6:30 pm


9:00 am-6:30 pm


9:00 am-6:30 pm


9:00 am-6:30 pm


8:00 am-1:00 pm