Chiropractic Intake Forms

We offer our paperwork on line so you can complete it in the convenience of your own home. 


Intake Forms

These forms let us know what’s happened, but perhaps more important, where do you want to take your health?  Please download, print and complete the appropriate form for the care you will be seeking at our office.

  Chiropractic Intake Form
  LaserMedix Intake Form
  Massage Therapy Intake Form
  Smoking Cessation Intake Form

Physiotherapy Intake Forms

If you are coming to our office for physiotherapy, please complete one of the following forms depending on your situation.

  Physiotherapy Intake Form
  Physiotherapy Intake for Motor Vehicle Accident
  Physiotherapy Intake for Workers' Compensation Board 


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.


Dr. Jans Ellefsen and Dr. Mike Cochran
164 Ochterloney Street, Dartmouth, Nova Scotia
(902) 464-BACK (2225)
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