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612-822-0149

Nokomis Chiropractic & Wellness offers our new patient form(s) online so it can be completed in the convenience of your home or office.

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!

Please Download and Print Forms By bringing them in filled out you will save some time on your initial visit.

Have you recently been in an Auto Accident?

If you have been involved in an motor vehicle accident within the last 12 months or still have an open claim for an older accident, please fill out this form if you would like us to pursue that avenue of payment.

Remember as a passenger, pedestrian or bicyclist who is injured during an encounter with vehicle, you may be entitled to coverage under the MN No Fault laws. Fill out the Auto Accident Questionaire form in addition to ones listed above.

Have you recently been in an accident at work or on the job?

If you are injured as a result of something that happened while at work, please include the Workers Compensation Questionaire when you are bringing in your forms.

If you have any additional questions or wish to talk with the doctor before your visit, please feel free to call 612/822-0149. If it is an urgent situation and you get the voicemail, press option 1 to be forwarded to the on-call staff person.


  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary forms, print them out and fill in the required information.
  • Bring them with you to your appointment.

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