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(479) 254-3999

New Patient Form

Impact Health NWA offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

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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!

New patients, click here and submit this form before your appointment!

New Patient Deposit Policy  

We request a $50 deposit to schedule and reserve your first appointment.  This deposit is applied to the cost of your first visit with us. 

Should you need to reschedule or cancel your first appointment, the deposit is refundable if you call us within 48 hours of your appointment time.  If we do not hear from you during this time period and you do not show up to your appointment your deposit is not refundable. 

Thank you so much for your understanding as we value your business.


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

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