Initial Child & Adolescent Questionnaire
Mainly for Moms:
Tell us about your pregnancy
The information I have provided on this form, is true and accurate to the best of my knowledge. I give Dr. Michael P. Griffin permission to render care today. This initial visit includes a health history/consultation, chiropractic exam/evaluation. I also give my consent to have the doctor order any x-rays that he deems appropriate, and any initial care that is determined to be clinically necessary and mutually agreed upon.
“My mission is to help as many people in my lifetime as possible, especially children.”
-Michael Griffin, DC
Electronic Health Records Intake Form
Office Use Only