Online Paperwork (Your Health History)

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.


New Patient Questionnaire

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?
 Click to Download & Print Form


New Patient Case History

Let us know about your health background.
 Click to Download & Print Form


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.

Mike Black Asks some important questions of interest to Clovelly residents - Chiropractor Clovelly Mike Black Asks...

Can chiropractic relieve PMS?
If you have nerve interferences, especially in the lower spine that impair nerves that direct and monitor the reproductive and hormonal systems, chiropractic could be helpful. Undetected nerve interferences may also be responsible for pelvic pain, incontinence, sexual dysfunction and even infertility. Maybe chiropractic can help. Find out!
What's the difference between a "good" drug and a "bad" drug?
As a chiropractor, I see the use of many drugs (legal or illegal) as merely symptom treating. Worse, virtually every drug produces unwanted effects. The effects of chiropractic are largely positive effects. If you're a Clovelly parent, consider carefully before giving your child a cough medication, cold remedy or pain reliever so this sort of question doesn't arise in the first place.