Paperwork

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.


Health History and Future

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?

 Download and Print Form ENGLISH 
 Download and Print Form SPANISH 


Automobile Accident

If your health issue is the result of a car accident, we need some additional information.

 Download & Print Form


Worker’s Compensation

If your health issue is the effect of an injury at work, this information will help us help you.

 Download & Print Form


Medicare

If your health issue is to be covered by Medicare, please complete this form.

 Download & Print Form


Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

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 Dr. Todd Asks some important questions of interest to Fort Myers residents - Chiropractor Fort Myers Dr. Todd Asks...

How do you know when you're healthy?
Ask most Fort Myers residents this simple question and you're likely to hear, "When you feel good" or "When you're at your proper weight for your height" or "When you have lots of energy and vitality." Great answers. But our chiropractic patients know that true health is when your body is working as it was designed. True health is how you function, not how you feel.
What's a side effect?
It may sound like a bonus; something extra, but chiropractors know it should more accurately called an "unintended effect," and "unwanted effect" or in some cases an "adverse effect." A pill can't come close to matching your body's ability to create and deliver the essential compounds it needs. That's when it's important to make sure your nervous system is working correctly—the purpose of chiropractic care!