Online Forms

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McDaniel Chiropractic Center offers our patient form(s) online so you can complete it in the convenience of your own home or office.

If you do not already have AdobeReader® installed on your computer, Click Here to download.
Download the necessary form(s), print it out and fill in the required information.
Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download Health History Forms

New Patient Pain & Daily Activities Assessment-Required

Let us know what your pain has been like and if you are having difficulty doing your daily activities. Please choose from one or more of the following forms that apply to your complaint(s):

Low Back Condition Assessment Form

Neck Condition Assessment Form

Other Conditions Assessment Form

Reactivating Patient Update Form

If you are a current patient and there has been a lapse in your care in our office, we require an Update Form to re-establish your care and document medical necessity. If you have not had an appointment in three years or more you will need to fill out the New Patient History forms above.

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

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Tue	8 am to 5:30 pm
Wed	8 am to 5:30 pm
Thu	8 am to 5:30 pm
Fri	Closed
Sat	8 am to 12 pm
Sun	Closed

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Lectures

We offer these lectures free of charge, they are part of our community service outreach programs. If you are interested in having us come to your group, please feel free to call us to discuss your needs.

Call 388-0970 to reserve a seat for any of the following lectures.

March 8 - "Against the Grain: What if Everything You've Been Told About Health and Weight Loss Was Wrong?" Join us on March 8 starting at 6 PM for an information filled hour and a half. Come learn why the high grain-low fat diet is keeping America sick and what you can do about changing your health. Call the office to save a seat today.

April 16 - "Paleo Implementation 101" Join us starting at 6 PM to learn how to save time and money while decreasing your cravings and increasing your energy. We will review tips on how to shop, cook, exercise and sleep and stay sane. Call to reserve your seat - 388-0970.

April 28- "Chi Running Clinic" - Dr. Jason Wolstenholme will be back to provide Level I and Level II chi running clinics. Join us on April 28 and learn how to use gravity and biomechanics to run with greater ease and less stress. They are three hour workshops that will give you hands on techniques to revolutionize your running. There is a nominal fee for this class and the class size is limited. Call 388-0970 today to reserve your spot. Level I will begin at 9 and level II will begin at One and end by 4 PM. There is a discount for doing both levels in one day. Dr. Jason is also offering a 15% discount for anyone participating in the first annual TJM Run for Lung Cancer Research. You can sign up for the 5K online at Evenbrite.com, keyword: TJM.

all lectures are offered at McDaniel Chiropractic Center. 1330 Exchange Street Suite 105 Middlebury, VT