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Maximal Health

New Member Intake Forms

Congratulations on taking the first steps to find out exactly how Dr. Black can help you regain your health and live the life you desire!

Please note that the forms below are age specific, please take your time and try to answer all the questions on the forms, if there are any questions or you are not sure how to best answer the questions we will assist you in doing so upon your arrival for your initial Consultation and Chiropractic Evaluation with Dr. Black.

Please print and bring the completed forms with you to your consultation with Dr. Black, we look forward to learning about your past health history and your current challenges and future expectations.

* If you need help or have questions about the forms, we are here to help!  Call (972) 409-0016 don’t hesitate to ask for assistance!


New Member Paperwork (10 years of age and older)

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Pediatric Paperwork (Birth to 9 years of age)

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What to expect on your initial visits! We don’t guess, we test!  Using the WORLD’S best technology! new-patient-forms


Providing Safe, Effective Chiropractic Care to Irving, Valley Ranch, Las Colinas and Coppell