New Patient Forms

Download by clicking on appropriate box below:

Adult and Student Forms Button


Infants and Children Forms Button





1. Download the form by clicking the box above. Check your download folder for the file. Print the document.
2. Complete the form in detail with all necessary information.
3. Call Back To Health Chiropractic Centre at (905) 303-1009 to book your consultation / exam.
4. Bring the completed form with you on your first visit.

Thank you!

Dr. Walter Salubro
Back To Health Chiropractic Centre
20 Cranston Park Ave, #6 Maple, ON (905) 303-1009

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Results from using our products and/or services may vary from person to person. Results are not typical.