Chiropractic Wellness Center
Dr. Eric Chu | (703) 323-0068
9689 Main Street, Suite B
Fairfax, VA 22031
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Nutritional Response Testing
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To serve our patients and our community with outstanding Chiropractic care so they may live healthier and happier lifestyle.

Patient Intake Forms

Chiropractic Wellness Center - FormsTo make your first visit a little easier, you can download and fill out the Patient History and the No Call / No Show forms before your arrival. This may save you 15 - 20 mins at your first visit. To download forms, click a link below.

» Patient History Form - Chiropractic

» Patient History Form - Nutrition Response Testing

» No Call / No Show Form

» Symptom Survey Form (A)

» Symptom Survey Form (B)

» Records Release Authorization - if you were under a previous Chiropractic care and would like that record to be sent to our office, please complete and forward it to your previous doctor's office.

Note: To view these forms you will need the free Adobe Acrobat Reader. If you don't have it, download it now by clicking here.