Online Forms

Semlow Peak Performance Chiropractic 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 Form- 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!

Download & Print Form

Medicare Patients only ABN form- Required

This form is for Medicare patients only and makes you aware of the charges that will not be covered by Medicare

Download & Print Form

Pain Diagram Form- Required 

This form allows us to review where you are experiencing your symptoms and pain

Download & Print Form 

Child Case History Form - Required

This form allows us to review the primary purpose for bringing your child in to see the Doctor.  We see many children in our office and we are here to help your family!

Download & Print Form 


Download the Free AdobeReader®

New Patients Receive $75 Initial Visit. Includes consultation, examination and x-rays.

Sign-up using the form or call us at 616-846-5000 to take advantage of this exclusive offer.

Office Hours

Our Regular Schedule

Monday:

7:30am - 1:00pm

3:00pm - 6:00pm

Tuesday:

8:30am -1:00pm

3:00pm-6:00pm

Wednesday:

8:30am - 1:00pm

3:00pm - 6:00pm

Thursday:

7:30am-12:30pm

closed

Friday:

8:30am - 1:00pm

3:00pm - 5:00pm

Saturday:

Closed

Sunday:

Closed

Location

Find us on the map

Testimonial

  • "I got my life back, I was 27 and feeling like I was 60, now I am feeling my age again."
    Brett S. / Grand Haven, MI

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