[et_pb_section fb_built=”1″ fullwidth=”on” _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_fullwidth_header title=”Patient Forms” text_orientation=”center” content_max_width_phone=”100%” content_max_width_last_edited=”off|desktop” module_class=”sub_header” _builder_version=”4.27.3″ _module_preset=”default” title_font=”||||||||” title_font_size=”90px” background_color=”#ffffff” background_image=”https:\/\/chiro.page\/demo7\/wp-content\/uploads\/sites\/70\/2024\/12\/shutterstock_570625726-scaled-1.jpg” max_width_phone=”100%” max_width_last_edited=”off|desktop” module_alignment=”center” custom_padding=”100px||100px||true” title_font_size_tablet=”” title_font_size_phone=”50px” title_font_size_last_edited=”on|phone” title_text_shadow_style=”preset3″ title_text_shadow_horizontal_length=”0.03em” title_text_shadow_vertical_length=”0.03em” title_text_shadow_blur_strength=”0.05em” box_shadow_style=”preset1″ box_shadow_vertical=”0px” box_shadow_blur=”46px” box_shadow_color=”rgba(0,0,0,0.58)” box_shadow_position=”inner” global_colors_info=”{}” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”2_3,1_3″ _builder_version=”4.16″ _module_preset=”default” background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”][et_pb_column type=”2_3″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.27.3″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]Please download and print the forms below and bring them with you to your first appointment. (Alternatively, if your office uses electronic health records, then the button will point to your EHR intake.)[\/et_pb_text][et_pb_button button_url=”#” button_text=”New Patient Intake Form” _builder_version=”4.27.3″ _module_preset=”default” custom_button=”on” button_text_color=”#FFFFFF” button_bg_color=”#0C71C3″ hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][\/et_pb_button][et_pb_button button_url=”#” button_text=”Informed Consent” _builder_version=”4.27.3″ _module_preset=”default” custom_button=”on” button_text_color=”#FFFFFF” button_bg_color=”#0C71C3″ hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][\/et_pb_button][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_image src=”https:\/\/chiro.page\/demo7\/wp-content\/uploads\/sites\/70\/2024\/12\/AdobeStock_87941728-scaled.jpeg” title_text=”Chiropractic doing spinal mobilisation” align_tablet=”center” align_phone=”” align_last_edited=”on|desktop” _builder_version=”4.27.3″ _module_preset=”default” hover_enabled=”0″ box_shadow_style=”preset1″ box_shadow_blur=”21px” box_shadow_spread=”5px” box_shadow_color=”rgba(0,0,0,0.15)” global_colors_info=”{}” sticky_enabled=”0″][\/et_pb_image][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.27.3″ _module_preset=”default” background_image=”https:\/\/chiro.page\/demo7\/wp-content\/uploads\/sites\/70\/2024\/12\/AdobeStock_272763288-scaled.jpeg” global_module=”14230″ saved_tabs=”all” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.27.3″ _module_preset=”default” header_font=”||||||||” header_2_font=”|||on|||||” header_2_text_align=”center” header_2_text_color=”#ffffff” header_2_font_size=”70px” custom_margin=”||20px|” header_2_font_size_tablet=”” header_2_font_size_phone=”50px” header_2_font_size_last_edited=”on|phone” header_2_text_shadow_style=”preset3″ header_2_text_shadow_horizontal_length=”0.03em” header_2_text_shadow_vertical_length=”0.03em” header_2_text_shadow_blur_strength=”0.05em” global_colors_info=”{}”]<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=”4.27.3″ _module_preset=”default” text_font=”|700||on|||||” text_text_color=”#eeefb3″ text_font_size=”30px” text_line_height=”1.1em” text_orientation=”center” text_font_size_tablet=”” text_font_size_phone=”22px” text_font_size_last_edited=”on|phone” text_text_shadow_style=”preset3″ text_text_shadow_horizontal_length=”0.03em” text_text_shadow_vertical_length=”0.03em” text_text_shadow_blur_strength=”0.05em” global_colors_info=”{}”]<\/p>\n
Get in touch with us<\/p>\n
[\/et_pb_text][et_pb_button button_url=”https:\/\/goelitechiro.com\/contact-us\/#appt” button_text=”Schedule An Appointment” button_alignment=”center” _builder_version=”4.27.0″ _module_preset=”default” custom_button=”on” button_text_color=”#ffffff” button_bg_color=”#06659f” button_border_width=”0px” button_border_radius=”40px” button_font=”Playfair Display||||||||” button_use_icon=”off” custom_margin=”10px|||” custom_padding=”10px|35px|12px|35px|false|false” box_shadow_style=”preset1″ button_bg_color_hover=”#d85326″ global_colors_info=”{}” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”on” button_bg_color__hover=”#d85326″ button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”]<\/p>\n
\u00a0<\/p>\n
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Patient FormsPlease download and print the forms below and bring them with you to your first appointment. (Alternatively, if your office uses electronic health records, then the button will point to your EHR intake.)Experience Real WellnessGet in touch with us\u00a0<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-14314","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/chiro.page\/demo7\/wp-json\/wp\/v2\/pages\/14314","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/chiro.page\/demo7\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/chiro.page\/demo7\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/chiro.page\/demo7\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/chiro.page\/demo7\/wp-json\/wp\/v2\/comments?post=14314"}],"version-history":[{"count":5,"href":"https:\/\/chiro.page\/demo7\/wp-json\/wp\/v2\/pages\/14314\/revisions"}],"predecessor-version":[{"id":14447,"href":"https:\/\/chiro.page\/demo7\/wp-json\/wp\/v2\/pages\/14314\/revisions\/14447"}],"wp:attachment":[{"href":"https:\/\/chiro.page\/demo7\/wp-json\/wp\/v2\/media?parent=14314"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}