Online Forms

Prax Chiropractic and Holistic Pediatrics offers our patient form(s) online so you can complete them in the convenience of your own home or office. In our effort to "Go Green" by going paperless, we now have our New Patient Intake Form online. 

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Please download the "required" forms below, print them out and fill in all the required information.  Please be as detailed as possible.  If something doesn't apply, please print "N/A" on that line. 
• When you are done, Make sure to hit the "Submit" button at the bottom of the page.
• If you should have any questions, feel free to call us at (434) 270-8971.

Fill out this form...

New Patient Intake Form - This form is an online PAPERLESS form.  Just click on the hyperlink and fill it out online.  Make sure to hit the "Submit" button when you are done.

Fill out this form if you are 10 years old or younger...

Required (ONLY to be used if the patient is 10 years old or YOUNGER)

Pediatric New Patient Health History Form

Required (ONLY to be used if you are pregnant)

Pregnancy History Form

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!