The Pollack Wellness Institute offers our patient forms online so they can be completed in the convenience of your own home prior to your appointment at our wellness center.

  • 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 first appointment.



New Patient Health History Form – Required

The history and current state of your health is very important to us, whether you’re looking for a natural weight loss plan or chiropractic adjustments. What questions, concerns and goals regarding wellness can we help you with? Let us know!

Download & Print Form



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, plus news and events in our office. You can print it out and bring it in to our office or Click Here to register online! We look forward to making your experience with our office and website more interactive and rewarding! Contact the Pollack Wellness Institute today to arrange your first appointment with a knowledgeable acupuncturist, nutritionist, or chiropractor near you and learn how our services can benefit your overall health and wellness!

Download & Print Form