JHWC

Online Forms

New Patient Paperwork

Make Your First Visit Smooth

To make your first visit as smooth as possible, we offer our patient forms online. You can complete them conveniently from home or the office — before you even arrive.

Please select and fill out the forms that correspond to the area of care you're seeking: Chiropractic, Functional & Holistic Medicine, or Mental Health Counseling.

  • If you don't already have Adobe Reader®, click here to download it.
  • Download the appropriate form(s), print them, and fill in the required information.
  • You may fax, email, or bring the completed forms with you to your appointment.

Fax completed forms

(904) 886-9804

Questions?

(904) 268-6568

Select Your Area of Care

Download Your Forms

Chiropractic, Massage, and Physical Therapy

Download, print and complete the new patient paperwork.

Mental Health Counseling

Download, print and complete the counseling intake paperwork.

Functional & Holistic Medicine Online Portal

Once your appointment is scheduled, you'll receive your unique username and password to access the portal.

Jax Health & Wellness Center

Contact Us

Schedule a Free Discovery Call

We'd love to hear from you! Whether you have questions, need more information, or want to schedule your free discovery call to see if we're the right fit — we're here to help.

Please do not submit any Protected Health Information (PHI).

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