Our popular Pediatric Intake Form is clean, professional and patient-friendly — making it the perfect first impression for your practice!

More importantly, by streamlining all the pertinent patient info you need to collect onto a single sheet of paper, they’ll make both patients and Docs equally happy by focusing only on the most important, well-organized information you need to lead the conversation about chiropractic and get more patients on a care plan that is right for them.

Each form includes the following sections:

  • Confidential Patient Information
  • Current Health Conditions
  • Health Goals for Your Child
  • Pregnancy & Fertility History
  • Labor & Delivery History
  • Growth & Development History
  • Acknowledgment & Consent
  • Customizable content area for your practice info

Key Features of all First Impressions Pro Forms:

  • Collects only the most pertinent patient information, making them faster and easier for patients to complete.
  • Organization and layout of information makes them more functional and efficient for chiropractors to find the info they need to recommend proper care.
  • Clean and modern designs – customized with your contact info make them perfect for any practice!

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