- We strive to provide complete care for our patients. Learn more about all the services we provide.
You are using an outdated browser. Please upgrade your browser to improve your experience.
The Pomperaug Chiropractic & Holistic Center offers patient forms online so they can be completed in the convenience of your own home or office. We ask that all new patients complete our New Patient Intake Form which you can complete at home and bring with you at the time of your first visit. Don't forget to bring it with you on your first visit! Additionally we ask that you please print and complete any other forms listed below which apply to you.
Update Patient Intake Form For returning patients who have a change in their Health status, Insurance, Address, phone, email, etc.
Auto Accident / Personal Injury Form For patients who have been involved in a motor vehicle accident or who have been injured and a potential liability exists.
Low Back Questionnaire To be completed by patients with low back pain - ONLY when requested by our office.
Neck Pain Questionnaire To be completed by patients with neck pain - ONLY when requested by our office.
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 and 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!
James T. Prado, D.C. ~ Charles W. Benson, D.C.
Southbury Connecticut ~ (203) 264-3583 ~ Contact Us
Serving Your Community for 30 Years
I have found everyone in the office so kind, knowledgeable and flexible. I would definitely feel comfortable referring others to this office.
What can we help you find?