Skip to content
1 (559) 635-82661808 South Central St Visalia, CA USA 93277
Facebook page opens in new windowYouTube page opens in new windowInstagram page opens in new window
Visalia Synergy Chiropractic
When You've Tried Everything Else…Synergy
Visalia Synergy ChiropracticVisalia Synergy Chiropractic
  • Synergy Home
  • Your Symptoms
    • Neurodevelopmental Disorders
    • Peripheral Neuropathy
    • Back Pain
    • Neck Pain
    • Headache
    • Whiplash – Auto Accident Recovery
    • Pain
      • CFS Fibromyalgia
      • Chronic Pain
      • Pain – One Body area
      • Pain – Several Body areas or both sides
    • Nutritional Functional Medicine
    • Weight Loss – Transformations
    • Toxicity – Testing & Solutions
    • Arthritis and Osteoporosis
    • Digestive Problems & Solutions
    • Dementia – Prevent & Reverse
    • Tinnitus Solutions
    • Scoliosis Solutions
    • Thyroid
    • Fountain of Youth
  • Contact Us
  • Paperwork
  • Reviews
  • Scheduler
Search:
Search
  • Synergy Home
  • Your Symptoms
    • Neurodevelopmental Disorders
    • Peripheral Neuropathy
    • Back Pain
    • Neck Pain
    • Headache
    • Whiplash – Auto Accident Recovery
    • Pain
      • CFS Fibromyalgia
      • Chronic Pain
      • Pain – One Body area
      • Pain – Several Body areas or both sides
    • Nutritional Functional Medicine
    • Weight Loss – Transformations
    • Toxicity – Testing & Solutions
    • Arthritis and Osteoporosis
    • Digestive Problems & Solutions
    • Dementia – Prevent & Reverse
    • Tinnitus Solutions
    • Scoliosis Solutions
    • Thyroid
    • Fountain of Youth
  • Contact Us
  • Paperwork
  • Reviews
  • Scheduler

Initial Paperwork (needs to be complete before first visit)

  • Initial Health History
  • Peripheral Neuropathy Intake form
  • Metabolic Assessment form (MAF) questionnaire (Note: Read each instruction carefully on the 2nd page.)

more Initial Paperwork for EVERYONE (although you do not need to print out)

  • Financial Policy Agreement
  • HIPPA Privacy Practices
  • Informed Consent – Chiropractic

Medicare forms

  • Medicare Payment Guidelines form

Other Condition-specific forms

  • Fatigue – Adrenal – Thyroid risk (FAT) profile questionnaire
  • Headache, Neck Pain, TMJD, Toxicity – Risk Profile questionnaire
  • Arthritis & Osteoporosis Risk Profile questionnaire
  • Intestinal Dysfunction questionnaire
  • Carpal Tunnel Syndrome
  • Temperature graph Fatigue – Adrenal – Thyroid

ADHD / Autism / Learning Disorders forms

  • ADD-ADHD Type Questionnaire
  • ADHD-High-Function-ASD-Fees

Accident & Injury forms

  • Auto Accident Questionnaire

Progress Report

  • Progress Report

Visalia Synergy Chiropractic
Copyright Synergy Chiropractic
Go to Top