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Patient Forms

Matzke Chiropractic / Patient Forms

New Patient History Form
This form tells us important information about your health concerns.

Pediatric Questionnaire
This form tells us important information about your health concerns with your child.
To be used for patients 12 years of age and younger. Please complete the new patient form above as well.

Automobile Accident
Complete the blue and black portions of this form if your health concern is due to an automobile accident.

Work Injury
Complete the green and black portions of this form if your health concern is due to an injury that occurred at work.

“Dr. Matzke helped me tremendously with a pinched nerve in my lower back. Follow up visits have helped me sleep better and feel better in day-to-day tasks. I would highly recommend Dr. Matzke for any chiropractics needs! Overall just a nice, genuine guy.”

Jon T.

“Dr. Matzke is a great chiropractor. He used multiple methods of adjustment with me. The front office staff was very nice, too.”

Sandra C.

“Whether you are looking for a new chiropractor due to an injury, or are looking to make chiropractic care a regular part of your life, you will not be disappointed!”

Kelsey T.

“I’ve gone to Dr Matzke for a couple different problems from headaches, lower back problems, and even a stiff neck from sleeping on my pillow wrong. He was very knowledgeable and thorough about each problem.”

Jason Z.

“My headaches and neck pain were so intense that I was missing work. After a few adjustments with Dr. Tom, I started to feel like myself again, and the pain finally went away! I highly recommend Dr. Matzke.”

Sarah J.

“I was going to have a root canal because I was having bad tooth pain and the dentist thought it may be infected, but after my adjustment the pain completely went away that day!”

Russ S.

“I have been able to walk and work more since we started care.”

Jim P.

“Ever since I started getting adjusted I have been able to cut the amount of insulin I need to take in half! Coming here is they only thing that I have done differently.”

Waylene S.