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Online Forms

Theriault Chiropractic 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 Health History Forms - Required

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! Please be sure to print and fill out both of the forms below.

Download & Print Form 1

Download & Print Form 2


Toxicity Questionnaire

Download & Print


Child Health Questionnaire

Download & Print


Auto Accident Questionnaire

Download & Print Form



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