Pediatric Forms

Dakota Chiropractic & Wellness Center offers our patient form(s) online so you can complete 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.
• Bring the completed form(s) with you to your appointment or fax it to our office at 605-339-8880.

Pediatric New Patient Forms (ages 0 - 3 yrs)

This lets us know the history and current state of your infant's health.

You will need the following forms:

Pediatric History Form

Financial Policy