The Houston Chiropractor to see - Chiropractor Houston

Online Forms

You must have Adobe Acrobat to view the forms, if not simply download Acrobat with the link provided below. After the download completes, just open the file, print out the forms, fill them out, and bring them with you, fully completed ahead of time, to your first appointment. All your information remains private within our office.


 Download New Chiropractic Patient Forms (To be completed prior to initial visit with Dr. Jackie)


 Download Child Health Profile & Permissions Form (To be completed by parent or guardian prior to initial visit with Dr. Jackie)


 Download Notice of Privacy Practices 



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Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.



Dr. Jackie St. Cyr, 2021 Driscoll Street, Houston, TX | (713) 521-2104
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Dr. Jackie Asks some important questions of interest to Houston residents - Chiropractor Houston Dr. Jackie Asks...

What's the difference between maintenance, prevention and wellness?
Maintenance chiropractic care is an attempt to keep a dynamic, ever-changing and adapting organism (you) in a static relationship with your environment. Preventive chiropractic care is mostly about early detection. Wellness chiropractic care is an attempt to optimize our health and be all that you were designed to be.
Can a chiropractor heal?
There's never been a case in which a doctor (chiropractor or otherwise) has formed scar tissue, mended a broken bone or cured a headache. Only you can do that. Turns out you're the doctor! All I do is help remove interferences to your body's healing ability. Ready to get started? Call our office today.