New Patient Intake And Referral Forms

Green Wave now offers several of our intake forms, packets, and our referral form in a downloadable format for your convenience. You can now complete them digitally, send them in or bring them with you:

Method 1. Select the form for your visit, complete the fields and save your copy. Then send it ahead of your visit to : [email protected]

Method 2. Select the form for your visit, complete the fields and save your copy. Then print it out and bring it with you for your visit.


  1. Counseling: We offer several types of counseling services. The packet required is based on the age of the client.
  2. Chiropractic Care: There are two basic types of packets depending on the type of patient.
  3. Neuropathy Intake Forms
  4. Massage Therapy Forms
  5. Nutritional Health Care
    1. Standard Process System Survey Form
    2. General Health & Wellness Patient History:  You may bring this to the free seminar. We use this form for the evaluation session and for the electronic health scan.
  6. Weight Loss: One for the free seminar and two for the optional evaluation session
  7. Green Wave Referral Form:  To be use by referring practitioners to facilitate our integration and coordination of new patient care.

If you need any more information on which forms to complete for your visit, don’t hesitate to call our office at (850) 215-5657!