Welcome to Legacy Family Chiropractic!

Please complete the following thoroughly and accurately as this information will help the doctor better understand your concerns and history.

Clicking on certain buttons reveals a space for you to add brief comments. Clicking on the "Submit" button on the final page will send this to our secure server. You do not need to email this form to us. However, please be sure to click "Agree" and add your written signature on the final page before hitting "Submit". This will take you to a confirmation page and ensure that the form is sent directly to us!

We look forward meeting you and seeing how we can help you!