- We strive to provide complete care for our patients. Learn more about all the services we provide.
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Evans Chiropractic & Pain Relief Laser Clinic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.
ALL NEW PATIENTS START HERE. No need to print this. Complete via the link below. 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!
Form takes approximately 20 minutes to complete.
Welcome to our group. :) We look forward to helping you feel better.
This lets us know the history and current state of your neck health
This lets us know the history and current state of your back health
Medication History - Required
This will the us know your current and former medication history.
Knee Pain Functional Scale - Required only if applicable
This lets us know the history and current state of your knee health.
This lets us know the history and current state of your hip health.
Arm and Hand Questionnaire - Required only if applicable
This lets us know the history and current state of your arm and hand health.
Leg and Foot Questionnaire - Required only if application
This lets us know the history and current state of your lower extremity health.
This form can be filled out to register for access to the member wellness section of our website. This will allow us to send you specific treatment instructions for home. You can print it out and bring it in to our office or Click Here to register online!
TMJ Disability Index - Required only if applicable
This lets us know the history and current state of your health
Mental Health Questionnaire - Required only if applicable
This lets us know you current and prior stress level
New patients receive a $39.00 consultation and examination - $150.00 value! (medicare rules apply)
Sign-up using the form or call us at 262-785-5515 to take advantage of this exclusive offer. You must mention that you saw this on our website. This cannot be combined with other offers. Good toward first visit chiropractic services only.
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The phrase, "No pain, no gain" is now obsolete in my thinking. I am restored to life, and I gained it without suffering pain.
After reading about Dr. Evans and her MLS Class IV laser therapy, (which did, by the way, actually relieve my knee pain without the use of braces, without any injections, or surgery) I put my faith in her and in the team at the office of Dr. Evans.
Following treatments my knee pain was relived by 90%. No kidding. It worked beautifully! The other 10% can be attributed, I believe, to my old age.
Due to my new found happiness, I am planning to start up a new Boy Scout Troop for Senior Citizens with this motto: "Be Repaired" by Dr. Evans. I feel lucky to have found the knowledgeable Dr. Evans and her staff at the Chiropractic, Pain Laser, and Acupuncture Center.