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Waupaca Chiropractic Center, S.C. offers our patient forms online so they can be completed it 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.

New Patient Health History Form - Required

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

Birth to Two Month Intake Form

Two Month to Two Year Intake Form

Three Year to Five Year Intake Form

Pediatric Intake Form (6+ years)

Adult Intake Form


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



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Exclusive Offer

New patients always welcome!

Please sign-up the form or call us at 715-258-8211 to take advantage of true health through chiropractic care.
Same day appointments are not guaranteed but certainly possible!

THIS ---->https://waupacachiropractic.com/new-patient-center/online-forms.html

Office Hours

Day
Monday8am - 12pm2pm - 6pm
Tuesday9am - 12pm2pm - 5pm
Wednesday8am - 12pm2pm - 6pm
Thursday9am - 12pm2pm - 5pm
Friday8am - 12pm2pm - 5pm
SaturdayEmergency
SundayEmergency
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8am - 12pm 9am - 12pm 8am - 12pm 9am - 12pm 8am - 12pm Emergency Emergency
2pm - 6pm 2pm - 5pm 2pm - 6pm 2pm - 5pm 2pm - 5pm

Testimonial

I was suffering from bad head and neck aches for months. I was skeptic about Chiropractic Care but since coming into Waupaca Chiropractic Center, my head and neck aches have VANISHED! I am a true believer and would recommend it to everyone to try! I haven't felt better than I do now. Thanks so much to Dr. Leean and staff!

Melissa
Waupaca, WI

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