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Hazeldean Family Chiropractic Clinic : Health History

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.


Health History and Future

This lets us know what’s happened, but perhaps more important, where you want to take your health.

Welcome Letter

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Health History – Age 10 and Up

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Health History – Birth to Age 9

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X-Ray Forms

In case x-rays are necessary, please take the time to print and complete the appropriate form below.

Consent for Radiology – Age 10 and Up

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Consent to Radiology – Birth to Age 9

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Free AdobeReader®

Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.


Hazeldean Family Chiropractic Clinic | (613) 831-9665