Chiropractie Brunssum Fitzgerald | Treatment of patients

Intake form, questionnaires and instructions for new patients

Intake form

  • Everyone must fill-out the intake form new patient AND the questionnaire that pertains most to your complaint. Bring the completed intake form new patient and the questionnaire to the first consultation.
    If for any reason you are unable to bring the completed intake form new patient, please arrive 15 minutes before your scheduled appointment to complete the intake form.

  • invulformulier nieuwe patient PDF  intake form new patient


Important for new patients

Most insurance companies do not require a referral by a Medical Doctor (MD) for Chiropractic treatment. You can call us directly to make an appointment.

If you have any other information concerning your condition such as X-rays, MRI’s or other medical information and/or tests, please bring them with you to your first appointment.


We guarantee a same day appointment for emergency cases.