New Patient Forms

Download by clicking on appropriate link below:

Adults and Students Age 14+

Infants and Children Age 0-13


1. Download the form by clicking a link above. Save and print.
2. Complete the form in detail with all necessary information.
3. Call Back To Health Chiropractic Centre at (905) 303-1009
to book your consultation / exam.
4. Bring the completed form with you on your first vist.

Thank you!

Dr. Walter Salubro

Back To Health Chiropractic Centre
20 Cranston Park Ave, #6
Maple, ON
(905) 303-1009