New Patients Welcome!

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    • Home
    • Chiropractic
    • About Us
    • Services
    • New Patients
    • Contact Us
    • Shop
    • Functional Medicine
  • Home
  • Chiropractic
  • About Us
  • Services
  • New Patients
  • Contact Us
  • Shop
  • Functional Medicine
Hello

Welcome

There's much to see here. So, take your time, look around, and learn all there is to know about our wellness center!

New Patient Forms

 

We offer our patient forms online so you can complete them in the convenience of your home or office.  Completing the forms in advance and bringing them along can help you save time at your initial visit. 

All new patients please fill out the New Patient Intake Form, Patient Health Questionnaire Form as well as an index corresponding to your complaint location.  If this is related to an auto accident or work injury please fill out the additional form.

Neck Pain Index (pdf)Download
Low Back Pain Index (pdf)Download
Auto Accident Questionnaire (pdf)Download
Worker's Compensation Questionnaire (pdf)Download
Patient Intake (pdf)Download
Patient Health Questionaire (pdf)Download

Policies

NON-DISCRIMINATION POLICY (pdf)

Download

HIPAANoticeofPrivacyPractices.docx (pdf)

Download

Verkuilen Chiropractic & Wellness Center

Verkuilen Chiropractic 1401 Elizabeth Street Shawano, WI 54166 US

(715) 524-6720

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