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Patient Health Record


Welcome to our Chiropractic Office.

Please fill out our confidential Patient Health Record completely
and accurately. One is for Acupuncture and one is for Chiropractic.  Chick on the one you want to print.

Patient Health Record for Acupuncture (pdf format)

Patient Health Record for Chiropractic (pdf format)

If you have any questions, please don’t hesitate to ask.


It is our pleasure to be of service to you. Our commitment to you is to
promote the highest quality of health and well-being via specific chiropractic care.




Pathways Chiropractic & Wellness
2600 Gateway Ave. Suite 2
Bismarck, ND 58503



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