Welcome to Skywalk Chiropractic & Massage
Our practice is committed to providing the highest quality patient care and helping you to achieve your personal health goals.
The following form is for you to complete before your first visit. This provides a general report of who you are, your past health history, and the current condition for which you are seeking treatment that your health care provider can review in preparation for your first visit.
You may choose to complete this from the comfort of your own home or office OR you may also complete it upon arrival for your first visit. If you prefer the latter option, please be prepared to arrive at least 10-15 min early for your appointment.
Name of Pediatrician
Date of Last Visit
At what age, in months, was the following introduced?
At what age was your child able to (in months):
Personal Illness History