Zeigler Chiropractic offers our Application for Care forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

New Application for Care (Adult)

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

New Application for Care (Child)

This lets us know the history and current state of your child’s health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!


  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment. Fax Number: (303)955-4547