303-431-8588

Online Forms

Alpine Wellness Chiropractic & Massage Therapy offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

ADULTS - Chiropractic

Adult New Patient Health History Form - Required

This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Fill Out Form Online

Download & Print Form

Adult Reactivation Form
(if you have not been seen in more than 1 year but less than 3 years)

This let's us know the history and current state of your health and gives us an update of your status since we saw you last. Also updates treatment consents and administrative records.

Download & Print Form

Patient Records Release

If another provider has records, reports or x-rays that we would like to request to have sent to us you will be instructed to complete and fax the other provider this form. Providers will not release records to us without this consent.

Download & Print Form


CHILDREN - Chiropractic

Child New Patient Health History Form - Required

This let's us know the history and current state of your child's health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

All Children Under Age 5

Developmental Milestones: Download & Print Form

All Children Under Age 7

Birth Records Release: Download & Print Form


PREGNANT MOMS - Chiropractic

Pre-Natal New Patient Health History Form - Required

This let's us know about your pregnancy so far and the state of your health beforehand. What questions, concerns, goals, regarding your pregnancy can we help you with? Let us know!

Download & Print Form


INSURANCE PAPERWORK

If you have one of the following insurances, additional paperwork is required:

United HealthCare Cypress Care Medical Resource, LLC
Great-West HealthCare Evercare Primera Blue Cross
PacifiCare Health Systems GE Wellness Plan Principle Life Insurance Co.
Secure Horizons Golden Rule, Inc. Reserve National
Align Networks, Inc. Health Allies Universal SmartComp

REQUIRED ADDITIONAL FORMS
All three forms are required.

Patient Summary Form: Download & Print Form

Neck Index: Download & Print Form

Back Index: Download & Print Form


MASSAGE THERAPY

How to Get the Most out of Your Massage

Download & Print Form

Adult New Patient

Intake: Download & Print Form

Pre-Natal New Patient

Intake: Download & Print Form

Pre-Natal Care Provider Release: Download & Print


MOTOR VEHICLE ACCIDENT FORMS

(In Addition To Above Paperwork) - Select Appropriate Age Group

Child MVA History: Download & Print Form

Adult MVA History: Download & Print Form


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Office Hours

Our Regular Schedule

Monday:

9:00 AM-12:00 PM

2:30 pm-6:00 PM

Tuesday:

Closed

Wednesday:

9:00 AM-12:00 PM

2:30 pm-6:00 PM

Thursday:

Closed

Friday:

9:00 AM-12:00 PM

2:30 pm-6:00 PM

Saturday:

Closed

Sunday:

Closed

Locations

Find us on the map

Testimonials

  • "could barely walk at 9 months pregnant she worked a miracle! My 5 year old is so much better also. Plus when I noticed that the new baby always held her head to one side and had a problem breastfeeding on one side we went in. They were able to fix it and it became so much easier to breastfeed and the baby is so much happier."
    Sarah S.
  • "I will shout it from the rooftop! This place has changed my life. I didn't even realize how much pain I was living with until Dr. D and Dr. J started my treatment. I'm so much more aware of my body and am nearly pain free. I'm stronger. I'm happier. I'm not self medicating anymore. They are miracle workers here! My heart is filled with gratitude."
    Jessica C.
  • Your Spinal IQ

    Your IQ that's measured in school has to do with problem solving - mental gymnastics. Your spinal IQ also has to do with problem solving - these are "problems" of the physical kind.How far to bend over to lift those grocery bags out of your car's trunk? How much muscle force is necessary to pick up and ...

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  • What's Your Sign?

    "Who you are speaks so loudly I can't hear what you're saying." This truism is well-known in human potential circles and can often be heard at personal growth-and-development seminars. But the implications of this meaningful phrase are often ignored in our day-to-day activities and relationships. Sometimes ...

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  • Vitamin D - The Superstar Supplement

    You may remember the public health slogan, "Vitamin D helps build strong bones". This message could be seen on colorful school posters and heard on radio and television programs as early as the1950s. Getting enough Vitamin D was a major health issue, primarily for its role in preventing childhood rickets ...

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  • Staying Well In Winter

    Simon and Garfunkel [and later, The Bangles] had it right. Winter light is hazy - it's more diffuse. The sun is lower in the sky and the sun's rays reach the Earth at an angle, losing much of their power. And of course, there's less sunlight during each 24-hour day of winter than during the rest of the ...

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  • Five To Stay Alive

    It's the rare child who actually wants to eat fruits and vegetables. Kids are bombarded by television and radio ads for cereals, candy, and chips that contain huge amounts of sugar and large quantities of saturated fat. The sugar craving begins in childhood - kids quickly develop a taste for sweets. ...

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  • Coming Up for Air

    Both Abraham Lincoln, 16th President of the United States, and Charles Darwin, author of The Origin of Species and creator of the theory of natural selection, were born on February 12, 1809. Modern evolutionary theory, of course, is based on Darwin's theory of natural selection. The evolutionary history ...

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  • Your Personal Health Insurance Policy

    Everyone is aware of the extremely high cost of most health care services. These costs can be measured not only in cash outlays, but also in time spent at a doctor's office. Waiting times can often be an hour or more for a comprehensive physical examination at a family physician's or internist's office. ...

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  • Your Personal Corporation

    You are the CEO of your own personal enterprise. In addition to whatever business you might be running or might be in, your personal corporation consists of the value you generate during your time on Earth. Some persons such as government officials make choices and take actions that obviously affect ...

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  • Your Inner Ecology

    In April 2010 the BP Deep Horizon drilling rig exploded in the Gulf of Mexico, resulting in a catastrophic offshore oil spill. Millions of barrels of oil have spilled into the Gulf since the explosion, representing an unprecedented environmental disaster. Many complex ecosystems are affected by the oil ...

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  • Will you be comming?

    An old cliche for getting to know someone in a new social situation entails asking, "What's your sign?" The notion, of course, is that a simple identifier such as astrological sign would provide grounding for a potential relationship - romance, friendship, or even a new bowling partner. As there are ...

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