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Request an Appointment

251-929-2095

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

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Click on the form below in either MS Word or PDF format to download your copy.

New Patient Health History Form - MS Word format
(form can be completed electronically and saved in Word)

New Patient Health History Form - PDF format
(form can be printed and filled out on paper)


After completing the New Patient Health History Form, please email the completed form to [email protected] or bring it with you to your appointment. Thank you!


Text Messaging Consent Form - Optional

If you would like to be able to send and receive text messages with Alexander Chiropractic for appointment reminders and changes, please complete the form below and bring it with you to your next appointment. Thank you!

Click on the form below in either MS Word or PDF format to download your copy.

Text Messaging Consent Form - MS Word format

(form can be completed electronically and saved in Word)

Text Messaging Consent Form - PDF format
(form can be printed and filled out on paper)


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



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