Online Forms

Dr. Judith Kanzic, D.C, F.A.C.O offers our patient form(s) 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 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.

New Patient Health History Forms - Required

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!

We ask that you download & print the following pages. 

Please have the following six following documents completed before your scheduled visit:

Patient History

Privacy Policy

Patient Authorization

PHI Disclosure

Informed Consent for Chiropractic Treatment

Pain Assessment

If you are a returning patient and it has been less than 3 years we ask you to fill out the following document:

Case History Update

If the patient scheduled to be seen is a minor, we also ask the parent or legal guardian to complete the following form as well:

Consent to Treat Minor

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Review By Our Satisfied Patient

  • "My back first went out when I was 21 years old. I came to see Dr. Kanzic when I was 44 due to a reinjury. I could NOT stand upright without pain. I could not sit or drive without pain. . Also, I could not pick up my child or anything more than 10 pounds without PAIN.."
    SP - Houston, TX