• 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

Informed Consent

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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