Network Wellness healing Center


Personal History form to complete

Click Here to view and print Personal History Form PDF 

Please print this form, fill it out and bring it to the office on your initial visit.

When filling out the Personal History, you will be asked about physical, chemical, and emotional stressors that go as far back as the womb. We believe that whatever goes to the back of your mind goes into the spine, and that the position, tone, and tension of your spine is determined by the past and present stresses in your life and how well you have adapted to these stresses. Stresses in your life may affect the health of your spine and nervous system. The good news is that when your spine changes, your life changes, and on your first visit you will have an opportunity for a happier and healthier spine and life. Do your best at filling out the Personal History form, and the Doctor of Chiropractic will go over it with you on your initial visit.

Please click on the following documents, to read prior to your visit and be ready to sign that you have read, understood and agree:

Informed Consent to Receive Network Spinal Analysis (NSA) Care PDF



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East side: 420 East 81th St. Suite 1

Midtown: 57 West 57 St, Suite 1204

Armonk, NY: 430 Bedford Road, Unit RT22, Suite 203

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