Patient Intake

Please Complete and Submit***

***By completing patient forms online, you accept the inherent risk of information being stolen, hacked, etc. This website is secured, but not all security is guaranteed. Maki Chiropractic Clinic does provide paper forms if you would prefer not to risk information being stolen or accessed by anyone other than Maki Chiropractic Clinic. All information submitted goes to a secured cloud through G Suite with Google.