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Van Hemert Chiropractic Family Wellness Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • Print out and fill in the necessary forms.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

PatientHealthHistory.pdf

AdultConsultationHistory.pdf

PatientIntroduction.pdf

If you need to download Adobe Reader, click here


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 chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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!

Sign up now or call us at 641-628-2099 to make your appointment!

THIS ---->https://vanhemertchiro.com/new-patient-center/online-forms.html

Office Hours

DayOpenClosed
Monday6:30 am6:00 pm
Tuesday8:00 am5:00 pm
Wednesday8:00 am5:00 pm
Thursday8:00 am6:00 pm
Friday6:30 am12:00 pm
SaturdayClosedClosed
SundayClosedClosed
Day Open Closed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
6:30 am 8:00 am 8:00 am 8:00 am 6:30 am Closed Closed
6:00 pm 5:00 pm 5:00 pm 6:00 pm 12:00 pm Closed Closed

Testimonial

I saw Doc when I was a senior at central college. He really took great care of me and the patients received great treatments. I just graduated chiropractic school 6 months ago and want to thank Doc for the motivation to pursue chiropractic school.

Joel M.
Pella, IA

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