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(519) 576-2222
Call your Kitchener Chiropractor Now

KW Health Connection offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.

Chiropractic 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!

Download & Print Form


Naturopathic Health History Form - Required

To make the best use of our time please complete the form and bring it with you to your appointment. Details will be taken when we speak together so brief overviews are preferred. If you feel a section does not apply to you then simply leave it blank.

Download & Print Form


Massage Therapy - Required

Let us know the current state of your health and what it is that brought you to our clinic.  Be sure to include all of your aches and pains, our therapists want to make sure you leave the best you possibly can.

Download & Print Form


Detox Questionnaire

A simple tool to see if you really need a detox

Download & Print Form



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