Client Health History Assessment

This form is required by first time clients only unless last visit was greater than 12 months.

Your progress cannot be saved. We recommend setting aside 15 minutes of uninterrupted time to complete this form.

This form is required by New Jersey State Law per N.J. Admin. Code § 13:35-12.18.

All information provided is protected by Hippa laws so please complete truthfully and thoroughly.

If you cannot complete this digital form, please arrive 15 minutes early to complete a printed version before your appointment begins.

Review our policies before you begin.