Online Forms

Located in Eden Prairie, MN, Midwest Chiropractic and Wellness offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Member Health Record- Adult - Required

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!

Download & Print Form- Front of Form

Download & Print Form- Back of Form


Member Health Record- Child-Required

 Download & Print Form-Front of Form

 Download & Print Form-Back of Form 


Download the Free AdobeReader®

New Patients: Currently Offering a $39 Exam and Consultation.

Office Hours

Our Regular Schedule

Monday:

8:00am - 12:00pm

2:00pm - 6:00pm

Tuesday:

9:00am - 12:00pm

2:00pm - 6:00pm

Wednesday:

8:00am - 12:00pm

2:00pm - 6:00pm

Thursday:

9:00am - 12:00pm

2:00pm - 6:00pm

Friday:

8:00am - 12:00pm

Closed

Saturday:

Closed

Closed

Sunday:

Closed

Closed

Locations

Find us on the map

Testimonials

Reviews By Our Satisfied Patients

  • "I started going to Midwest several months ago. I do strength training, and am also a mom of 2 toddler boys, so my body gets "out of whack" regularly. Dr. Jen has been amazing at targeting my problem areas and reducing pain specifically in my lower back, hip and shoulder. It has become routine for me to go now, and I look forward to every visit!"
    Lindsay B. / Eden Prairie, MN

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