(712) 256-2561   300 W. Broadway, Suite 712, Council Bluffs IA 51503
Located in the southwest corner of the Omni Centre in downtown Council Bluffs

Please print out the forms needed below or arrive 15 minutes early to complete our forms.
If you have insurance cards, please bring those along with you and a photo ID, such as a Driver's License.

CHIROPRACTIC FORMS:
1.  New Patient Forms
     (3 pages, same form used for chiropractic, massage, and yoga.)
2.  Pediatric History Form
     (Ages newborn - 12 years old)

MASSAGE FORMS:
Massage paperwork

WELLNESS CLASS FORMS:
1.  Yoga paperwork

2  Class Registration Form
     (To be used for each class or wellness event  you're registering for.)

The reason that we use the same New Patient Forms for chiropractic, massage, and yoga is because then if you use any of our services, you won't need to fill out more paperwork!

www.PrairielandsChiropractic.com