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Spend less time at the office!

If you’d like to fill out some basic paperwork in advance of your first appointment, you can download and print our intake forms here.

There are some forms that must be filled out in person. If you do not find what you’re looking for, please call us at (920) 388-3440 and our friendly staff will assist you!

New Patient Intake Packet

AGES 13 & UP
All new Steele Chiropractic patients, ages 13 & up, must complete this form.

Pediatric Intake Packet

AGES 12 & UNDER
All new Steele Chiropractic patients, ages 12 & under, must complete this form.

Workers Compensation Intake Packet

If you are visiting us for a Workers Compensation claim, this form must be completed prior to your first appointment.

Auto Accident Intake Packet

If you are visiting us as a result of an Auto Accident, this form must be completed prior to your first appointment.

Nutritional Intake Packet

If you are visiting us for a Nutrition Consultation, this form must be completed prior to your first appointment.

Authorization for Release of Medical Records

Consent to release your medical record information to Steele Chiropractic.

Comprehensive Adult New Patient Patient Packet (Ages 12+)

Patients of  Dr. Danielle Leick
AGES 12 & UP
All new patients, ages 12 & up, must complete this form.

Comprehensive Pediatric New Patient Packet (Ages 0-12)

Patients of  Dr. Danielle Leick
AGES 12 & UNDER
All new patients, ages 12 & under, must complete this form.

Don’t see what you need?

Call us at (920) 388-3440 to see if the form is available to be completed outside of the office.