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Phone: (701) 852-0158
Fax: (701) 852-5630
Email: cac@srt.com
Travis Roedocker, D.C.
Brenden Howe, D.C.
Christopher Falcon, D.C.
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New Patient Forms
Print, compete, and bring into the clinic for your first visit or scan and email forms to cac@srt.com
New Patient Forms if you are seeing Dr. Roedocker, Dr. Howe, or Dr. Falcon
Patient Registration
Please fill out personal information to the best of your ability.
Pediatric Health History
For children please fill out personal information to the best of your ability.
Patient Health History
Tell us about your past and recent injuries, surgeries, and medications.
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Financial Policy
Let us know who is responsible for your chiropractic visits.
Appointment Reminders
Chiropractic Arts Clinic may need to use your personal information to contact you.
Consent to be Treated
Understand that their are risks.
No Show/ Cancellation Policy
Understand that you are responsible for letting us know if you are not going to make an appointment.
HIPAA Privacy
We will not share any of your information without signed consent.
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