Skip to content

Please fill in the form New Patient Questionnaire - Megan

Megan's Intake Form

Dr Megan Azer

Chiropractor & Certified NET Practitioner

Welcome! Please fill in this form to the best of your ability. 

Patient's details

Health Concerns

Health History

Other Systems Review

Wellness Check

Please complete this online wellness check and email your results to
Thank you.


Please read prior to your consultation. This will be discussed further during your initial visit.
We will conduct a thorough history and examination to ensure the safety of your care.

Chiropractic care is recognised as being an effective and safe method of care for many conditions. However, you must recognise that there are risks associated with all health care procedures which you should be informed about. Please read the following carefully:

1. I acknowledge that I have discussed with Dr M. Azer the rare risks associated with my proposed care which include although are not limited to muscle and joint soreness or strains, nausea and dizziness, fractures, disc injuries, strokes (or like episodes) and an exacerbation and/or aggravation of my underlying condition.

2. I also acknowledge the following additional potential risks insofar as my proposed care is concerned have been explained to me  (to be discussed during your initial consultation).

3. I have had the opportunity to discuss the proposed care with Dr M. Azer I also acknowledge that I have had the opportunity to ask questions about the nature, extent and purpose of the proposed chiropractic care and that I have been given sufficient time to make a decision giving consent for the care to proceed.

4. I acknowledge that I am aware of and understand the potential risks. I appreciate that results are not guaranteed.

5. I do not expect the practitioner to be able to anticipate all potential risks and complications associated with the proposed care.

6. I hereby acknowledge my consent to the performance of the proposed chiropractic care by: Dr M. Azer and/or any other chiropractor working in this clinic. I understand that I can withdraw consent at any time.


I have read the above and agree to discuss any concerns with Dr Megan Azer during my consultation and prior to treatment.

Sign Here