New Patient Forms

- Emergency Services

- Over 10 Years of Experience

- Locally and Family-Owned

- Emergency Services

- Over 10 Years of Experience

- Locally and Family-Owned

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Convenient Online Forms

We offer our forms online so they can be completed in your home or office before you even arrive at our chiropractic clinic. At Premier Upper Cervical Chiropractic, we believe in patient convenience.


  • 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 Form — Required

This information 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! Feel free to request a call back to begin your service!


Download and print form

Emergency Services

Call us during emergencies and we'll provide you same-day service.

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They are always great and listen to what you need each time.

- Sherrie McKenzie via Google

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Premier Upper Cervical Chiropractic

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