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913-631-8888
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SPECIAL OFFER, NEW PATIENTS RECEIVE FREE CONSULTATION.

Balderston Chiropractic 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, print it out and fill in the required information.
  • Bring your completed form with you to your appointment.

New Patient Health History Form

We hate paperwork and so do you. But in today's healthcare delivery system we are forced to obtain full and accurate information for your medical record. We appreciate your cooperation. This lets us know the history and current state of your health.

Please fill out the forms completely.

Download & Print Form  - Required for all new patients. Please bring completed forms on initial visit.


 New Pediatric Patient Health History Form (9 years old and younger)

Dr. Gabel cares for your children and wants to get the most accurate information to provide the best care possible.  We appreciate your cooperation in filling out this form the best you can to help us get the information we need.  Weather an infant or older birth history can be important as it may have influenced a current condition.
Please fill out the forms completely.
Download & Print Form  - Required for all new pediatric patients, (9 years old and younger).  If your child is 10 years or older, please fill out New Patient Health History Form see above. Please bring completed forms on initial visit.
Returning Patient Update Form

Have a new injury or a different complaint or just haven't seen your doctor in a while. We hate paperwork and so do you, but it is important that we have your most recent and accurate information for your medical record. Let us know the history and current state of your condition. We are glad to provide care for many conditions that you may have.

Please fill out the forms completely.

Download & Print Form  -  Existing patients only. Please bring completed forms on your next visit.


Motor Vehicle Collision/Auto Accident Form

If you were involved in an automobile accident your injuries sustained maybe more than you realize.  It is important that we look at the whole picture and get the most accurate information about the accident, your health, and any treatment already provided, to help us provided you with most accurate diagnosis and evidence based treatment.

Please fill out the forms completely.

Download & Print Form - Required for all patients, both new and existing.  Please bring completed forms on your next visit.



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Services
We strive to provide complete care for our patients. Learn more about all the services we provide.
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Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.
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