Forms

First Visit

We are always excited about meeting new practice members during their first visit to our office. This important visit will give us insight into your chiropractic needs. During this time, we will help you get acquainted with our office and help you learn about your chiropractic care. We understand that each patient's care is different, and we promise to give you the personal attention you deserve.

When you enter the office you will be greeted by a friendly team member who will give you an office tour and gather all necessary information regarding your care. Dr. Manza will then conduct a thorough history and examination to determine areas of concern. All patient x-ray examinations are sent to the radiographic professionals at B & I Imaging who will fax a detailed analysis of your findings directly to Dr. Manza. Dr. Joe will also personally review the x-ray images as well.

After your records have been evaluated, Dr. Manza will explain the care plan and schedule and answer any questions you may have. If treatment is indicated, we will discuss insurance coverage and what appointments are necessary in order to begin.

It is our goal to make this experience as pleasant and simple for you as possible.

Initial Paperwork

Please print and fill in these two forms to the best of your ability and bring with you to your initial visit.

• Health Questionnaire
• Pain Scale

Pediatric Paperwork

Please print and fill in this form to the best of your ability and bring with you and your child on the initial visit. Please fill in one form for each child.

• Pediatric Consultation