Online Forms

Holt Chiropractic Center offers our patient forms online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary forms, print them out and fill in the required information.
• Please make sure to print both the New Patient Registration Form as well as the appropriate Case Histrory Form (Child, Adolescent, Pregnant, or Adult).
• Fax us your printed and completed forms to 517-699-5434 or bring them with you to your appointment.

New Patient Information Form - Required

Download & Print Form

Child Case History (ages 0-8)

Download & Print Form

Adolescent Case History (ages 9-17)

Download & Print Form

Pregnant Case History

Download & Print Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!