Patient registration form

Please download the ‘patient registration form’ and complete it in your own time and handwriting and email the form to the clinic when completed. We will contact you within 12 hours, if not before, to let you know if our chiropractors can help you. If not, we will recommend where to go for help.

Alternatively, if you have already booked an appointment, bring it with you completed to your initial consultation. This will save you approximately 20 minutes time at the clinic.

Please feel free to call our helpful reception staff if you have any queries at all on this. Thank you.

Telephone no: 01626 202026.

Please note that all fields and boxes must be completed before you send the form. If a question does not apply to you, then please reply with the letters 'na'. Incomplete forms will unfortunately have to be completed by you before the consultation. Thank you.