Northeast Spine & Wellness Center

Admitting Paperwork

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.

Patient Intake Form

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?
Download & Print Form

Automobile Accident Intake Form

If your health issue is the result of a car accident, we need some additional information.
Download & Print Form

Worker’s Compensation Intake Form

If your health issue is the effect of an injury at work, this information will help us help you.
Download & Print Form

Free AdobeReader®

Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

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Dr. Jay Asks...

Would you rather feel good or be healthy?

Ask most people in Clark and they want to feel good. Careful! Would you take medicine that makes you feel good, rather than vomit to expel improperly prepared food? Every chiropractic patient knows that you can't measure your health by how you feel. True health is when your body works as it should.

What's your plan to deal with drug-resistant 'super germs'?

Chiropractors have always been concerned with the indiscriminate use of antibiotics, accelerating the mutation of microbes that make "wonder" drugs increasingly ineffective. My strategy? Do everything possible to bolster my immune system through proper diet, rest, exercise, clean air, pure water and an optimally functioning nervous system with regular chiropractic care.