Are you in pain right now?

If pain is hindering you from fully enjoying life, we have good news. Our team of doctors is here to help you find the right solution for your lifestyle. To get started on your journey to health, take a few minutes to answer the questions below. After you have filled out the form, our team will review your answers and contact you with practical options for your specific needs. We look forward to helping you take the first step to a healthier you!

  • Tell us about the pain you are experiencing...

  • MM slash DD slash YYYY
    0 = no pain, 10 = most severe pain
    0 = no pain, 10 = most severe pain
    0 = no pain, 10 = most severe pain
  • MM slash DD slash YYYY

  • Let's go over your muscular, skeletal and nervous systems...

  • Tell us about your medical history...

  • Now, we'll cover your work life...

  • To get a complete picture, let's cover your health and lifestyle...

  • Just a few more questions so we can help...

  • We work hard to keep your information safe. Please read and acknowledge the text below.

  • We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notices of our privacy practice. We protect your health information and what rights you have regarding it, if we need to disclose your health information outside of our office for these reasons we will ask for your written permission. If you would like a copy of this policy please feel free to email or call our office and we would be happy to provide it to you.
  • Please note, submitting this form does not substitute for an office consultation. By submitting this form, no Doctor-Patient relationship is formed with Tuck Chiropractic Clinic. We will require you to come in for an in-office consultation. This will ensure that any care we provide is customized for each patient. It is important to remember that any information received through this website and email cannot be guaranteed to be confidential because of the possibility that a third party could intercept the message. Of course, once our office receives the information, it will be maintained in a confidential manner.