Printable Online Forms

Pure Wellness offers our patient form(s) online so they can be completed 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 lets 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 & Print Form

Primary Complaint Form

Neck Disability Index-For those patient who experience any neck discomfort, please print and fill out this form prior to coming to the office.  OR, you can also fill in the Neck Disability Index form and submit it.

Download & Print Neck Disability Index

For those patients experiencing Low Back Pain, please fill out the appropriate form below.

Low Back Questionaire for pain more than 30 days.

Acute Low back pain Index  for pain less than 30 days.

Progress Report questionaire is to monitor the patient's progress and update improvement.  Please fill this out prior to your scheduled re-evaluations.

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!

Download & Print Form

Massage First Visit Intake Form(Required) 

Massage New Patient Form

Massage Therapy Cancellation Policy

Please fill out this form for your first massage visit to our office.  This will allow our therapist to begin your first massage in our office promptly upon your arrival.
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