• Masters Human Nutrition, Chiropractic Kinesiologist, Applied Clinical Nutritionist.

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Patient Forms

Below is a list of potential forms for new and/or existing patients. Dr. Jurica will advise on which ones to complete prior to any appointment.

Initial Form

Health Form

Hipaa-and-Consent-Form

Consent to Treat Minor

Adrenal Questionnaire

Five Brain Systems Checklist

Toxicity Questionnaire

Hypoglycemia Questionnaire

Neck Pain Scale Form

Low Back Pain Scale Form

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