Welcome to Goldsworthy Chiropractic & Wellness Center
Welcome to Goldsworthy Chiropractic & Wellness Center
 

Please bring the appropriate forms (completed if possible) with you for your first visit. If you decide to fill these forms out at the clinic, please arrive 15 minutes early for your appointment.

Note: All these forms are in PDF format, you will need a PDF reader. Get one here for free. Click Here.

For all new clinic patients: Patient Privacy Consent Form
   

Your 1st visit with Dr. Jeff Goldsworthy:

Chiropractor

Patient Privacy Consent Form
Chiropractic Welcome
Chiropractic Confidential Information Form
Symptoms Form
Patient Consent to Chiropractic

   

Your 1st visit with Dr. Ryan Larson:

Chiropractor

Patient Privacy Consent Form
Chiropractic Welcome
Chiropractic Confidential Information Form
Symptoms Form
Patient Consent to Chiropractic

   

Your 1st visit with Dr. Robin Walsh:

Naturopathic Doctor

Patient Privacy Consent Form
Naturopathic Patient Intake Form
Declaration and Consent to Treatment Form
Diet Diary Form
Pediatric Intake Form

   

Your 1st visit with Dr. Ashley Knight:

Homeopathic Doctor,
Health Care Facilitator

Patient Privacy Consent Form
Consent to Health Care Facilitation or 'MAP' visits
Homeopathic Intake Form

   

Your 1st visit with Kyle:

Massage Therapist

Patient Privacy Consent Form
Massage Therapy New Patient Forms

   

Your 1st visit with Pam:

Massage Therapist

Patient Privacy Consent Form
Massage Therapy New Patient Health History Form

Massage Therapy New Patient Consent Form

   

Your 1st visit with Tara Blain:

Shiasu/Acupuncture

Patient Privacy Consent Form
Shiatsu Massage
Acupuncture therapy

   

Your 1st visit with Christa:

Detoxification

Ion Cleanse Detoxification Fee Chart: Call Centre for details
   

Your 1st visit with Betty Ann:

Kinisiologist

Kinesiologist/Ergonomics Fee Chart: Call Centre for details
 
 
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