Please complete the forms on this page before your first visit with Dr. Jerry. 

Online Google Document Packet

You can either complete the forms online by filling out this Google Document packet and emailing it to Dr. Jerry. NOTE: It will be easier to complete this Google Document packet on a laptop or desktop computer rather than a mobile device. 

PDF/Print Version of Forms

Or, print the following forms, fill them out, and mail them or bring them to your visit with Dr. Jerry. 

1. Chiropractic Registration and History (make your own copy to edit - you must be logged into Gmail first)

2. Health History 

3. Informed Consent to Chiropractic Adjustment & Care

4. Metabolic Assessment

5. Brain Health and Nutrition Assessment

6. Neurotransmitter Assessment

7. Body Stress Assessment Form

8. Hormone Assessment Form

9. Genetic Profile Questionnaire (make your own copy to edit - you must be logged into Gmail first)

Additional Resources

10. Alkalizing Foods

11. Alkaline, Anti-inflammatory, Anabolic, Low-Glycemic Diet

12. Vitamin Chart Part 1 & Part 2