Intake Forms

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. Include a Terms of Acceptance with your specific form and you are on your journey to health and wellness.


Adult Intake

 Download & Print Form


Child Intake

 Download & Print Form


Infant/Todder Intake

 Download & Print Form


Expecting Mother Intake

 Download & Print Form


Motor Vehicle Collision and Personal Injury

 Download & Print Form


Worker’s Compensation Injury

 Download & Print Form


Three Step Detox Symptom Questionaire

This tool helps screen whether a Three Step Detox program is right for you.
 Download & Print Form


Terms of Acceptance

When a person seeks chiropractic health care and we accept a person for such care, it is essential for both to be working towards the same objective.
 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. Denery Asks some important questions of interest to Baxter residents - Chiropractor Baxter Dr. Denery Asks...

Do nerves actually get pinched?
Chiropractors recognize two types of nerve disorders involved in subluxation. The least common is a pinched nerve that diminishes nerve supply to an affected organ or tissue. More common is the irritated nerve (facilitative lesion) which overexcites nerve communications to an affected organ or tissue. Chiropractic care has been shown to help with both types.
Why are frequent visits advised when starting chiropractic care?
Consistent visits at the beginning of your chiropractic care help create the momentum necessary to correct and retrain unhealthy spinal patterns. Later, Baxter practice members find that continued care on a less frequent visit schedule can help preserve their progress and avoid a relapse.