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712-256-2561

Prairielands Chiropractic Clinic offers forms online so they can be completed at your convenience, submitting online or printing and bringing with you.

  • Complete and submit online or download the necessary forms. If you do not already have AdobeReader® installed on your computer, Click Here to download.

Please complete our 2 forms for new patients:
New Patient Online Form or Print Form
Health Intake Online Form or Print Form

New Pediatric (birth-12 years old) Patient Online Form or Print Form

Do you have a claim number and need to be a new personal injury patient? New Personal Injury / Work Comp Online Form or Print Form

Massage Consent Online Form or Print Form
If pregnant, do this also:  Pregnancy Massage Informed Consent Form or Print Form

Print Yoga Waiver Form


Print 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 clinic. 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!


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