New Patient Intake Form

Dr. Nicole Shutko Chiropractic Center offers our patient intake form(s) online so they can be completed in the convenience of your own home or office.

• All forms are PDF files. You will need AdobeReader® to view them.
• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print them out and fill in the required information.
• Fax us your printed and completed form(s), bring them with you to your appointment or e-mail them to healthchoicechiropractic@gmail.com.