Thank you for your consideration of Ciccone Family Chiropractic – A Wellness Way Affiliate, Lancaster, MA for your health needs. Let’s get started!

 
These forms cannot be filled out using a tablet or mobile device as they are not compatible…Thank you!

Questions about the process of becoming a Wellness Way patient? Please review our frequently asked questions!

Step 1

PLEASE NOTE! This file must be saved to your desktop before and after completing! 

Complete the Health History Questionnaire. Email this document to our office to the email address provided in the form.

 
Attention Parents/Guardians: If you have a child age 10 or under, you will need to print out and complete the Pediatric History Form and not the Health History Questionnaire listed above. Bring this form with you to the office for your first appointment!
 

Step 2

Print out and complete the Signature Pages. Bring these forms with you to the office for your first appointment!

Step 3

Complete the Functional Assessment Questionnaire online. This health review takes approximately 30 to 40 minutes to complete.