Patient Forms

1. Progress Exam Form

2. Updated HIPPA Form

3. Consent for Treatment Form

4. ADL'S (Activities of Daily Living *Required Form*)

5. Headache Disability Assessment Form

6. Oswestry LOW BACK Functional Assessment

7. Oswestry NECK Functional Assessment

Contact Us

Locations

Find us on the map

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Family Life Chiropractic and Wellness

Address

430 Main Street
Wellsville, KS 66092, United States

Contact Information (785) 883-9355