Cornerstone Family Chiropractic
1285 2nd Ave East
Owen Sound, Ontario N4K 2J2




Thank you for choosing our clinic as your next step for better health! Today in Canada, and the rest of the western world, the main priority in health care is to help people after they are already sick. That is a backwards approach to health care, and it is why as a nation we are getting sicker and sicker.

Recently a medical researcher stated it plainly, "We are not living longer we are dying longer." In other words, we have the capacity to keep people alive longer, but the majority of these people do not have a good quality of life. They cannot do most of the things that would allow them to live FULL OUT lives.

That is exactly what we are 100% committed to in our clinic and we want the same for YOU! We are here to help you live a longer, healthier, and adventurous life!

It is important to understand that your current state of health or problem is mostly likely a reflection of events, habits, and incidents that you have accumulated. Most health problems are multi-factorial in origin. The only exception would be an acute trauma like a car accident or severe sports injury. Even with acute traumas, the extent of the injuries is most often dependent on your health before the accident.

Your life is a unique story. As such this initial intake form ("Health Profile") is part of our LIFE RESTORATION+ SYSTEM and we use it to get a better understanding of your current state of health and any problems you may be experiencing.

The 1st section called DISCOVERY helps us understand your past health history and traumas. It is a well-known fact that 80% of the risk factors for the two most feared killers; heart disease and cancer, are lifestyle related. The same is true for the majority of chronic illnesses affecting people today. For this reason we will ask you a series of questions regarding your lifestyle and day to day life. Your unique answers may lead us to the reasons you are experiencing pain, discomfort or poor health.

The 2nd section is all about your current CONDITION. It will help us understand how you are doing right now and give us a detailed picture of any symptoms or health problems you are experiencing.

The 3rd section of this form is entitled IMPACT, is one of the most important. You are not your condition but it does affect your life. We want to know how your condition is impacting your life on personal, emotional and relational levels and what your motivation, hopes and goals are for the future.

The FINALIZE section is the last part and includes some required consent forms to be signed before we start.

Please complete and submit this form to the best of your ability BEFORE coming to your first visit. This way we will better understand your problem and be more equipped to help you find a solution.