Patient Forms

We will strive to accommodate your request. Your appointment is not scheduled until you receive an e-mail or phone call from the clinic confirming your time. Schedule an appointment with our online form!

Please print the following forms using the print function of your browser. You can then sign the forms and bring them with you to your first appointment. These forms will not be submitted via the Internet, so security is not an issue.

Adult Health Record

Child Health Record

Newborn to 3 years

Age 4 - 8

Age 9 - 13

Thanks for visiting our site. We look forward to meeting with you in person and learning how chiropractic can fit into your health care goals. Give us a call or send us an email and we can arrange a time to explore your options!

Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Drs. Todd & Sonya Wolter
2304 Hurstborne Village Drive, Suite 100, Louisville, KY502-493-2400