Minnesota: 612.522.BACK
Toll Free: 877.325.BACK

Patient Forms


Upon entering our office, our receptionist will welcome you as a member of our family.  We will request that you complete New Patient paperwork specific to the reason for your visit.  These forms provide us with your health history and important information on your condition.

Cultural Chiropractic offers our patient forms online so that you may complete them in the convenience of your own home or office.

If you do not already have Adobe Reader installed on your computer, Click Here to download.

  • Download the necessary forms, print them out and fill in the required information.
  • Fax your completed forms back to our main office or bring them with you to your appointment.  Our main office fax number is 612-522-9537.

New Patient Health History

Auto Accident Intake

Work Injury Intake