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Wheat Ridge Chiropractor | Wheat Ridge chiropractic care | CO | Forms

Holland Chiropractic & Acupuncture Clinic


Connecting Science, Evidence Based Care, Experience and Clinical Insight




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We would like to take this opportunity to welcome you as a member of the Holland Chiropractic and Acupuncture office.

During your first visit, we will perform a comprehensive case history as well as a thorough orthopedic and neurological evaluation. Our goal is to become acquainted with your body's current state of function.  By understanding your body's function, we can better determine the underlying cause of your condition and desigh a method of care specific to your circumstances.

Enclosed is some important information for you to complete prior to your first visit.  This information is essential for us to begin our assessment of your case.  Please print and fill out the appropriate form below (note- some forms have multiple  pages). 




The appropriate forms must be completely filled out prior to your visit.  Our office manager will tell you which forms are appropriate to your particular case. Please bring them with you on your scheduled appointment.  In addition to the above documents, please bring in any recent diagnostic test results pertaining to your complaint (i.e., blood test, surgical report, x-rays, CT's, MRI's with reports, etc.)

 One Moment...

If you are an ACN, United Healthcare, United Healthcare of Colorado, Secure Horizons, or Medicare Complete Secure Horizons member, please complete the following Patient Notification Form, Back Index Form, and Neck Index Form needed by your insurance carrier.  The forms can be downloaded by copying the links below to your address bar and printing out the form.  

Again, we welcome and appreciate you choosing this office for your healthcare. 

If you have any questions please do not hesitate to call us at  303.422.7767.




-- Our office location --

6295 W. 38th Avenue

Wheat Ridge, Colorado 80033.5055