Patient Forms

Save time before your first visit — complete your paperwork online. It's secure, encrypted, and there's nothing to print or bring. Prefer paper? You can still fill everything out when you arrive.

Find Your Forms

Not sure which you need? Pick the group that fits your visit and click to fill it out online.

Nutrition Response Testing

New to nutrition care with Dr. Pearce? Start here.

New Patient / New Consultation Intake

Symptom Survey

New Patient Intake Symptom Survey

Chiropractic Patients

New chiropractic patient? Start here.

New Patient / New Consultation Intake

Review of Systems

New Patient Intake Review of Systems

Injured in a Car Accident?

Please complete these instead of the standard intake — they cover your info plus your accident and injury details.

Auto Accident / Personal Injury Intake

Review of Systems

Auto Accident / Injury Intake Review of Systems

Helpful Downloads

These two are yours to keep — download and review anytime.

Notice of Patient Privacy

How we protect and use your health information, and your privacy rights as our patient. Nothing to fill out or send back.

Download Privacy Notice

Daily Record of Food Intake

A simple sheet to track what you eat and drink over a few days. Download it, jot things down as you go, and bring it to your appointment.

Download Food Diary

Your privacy matters. These online forms are hosted on a secure, HIPAA-compliant platform — your answers are encrypted and go straight to our team. No printing or faxing needed.

Questions? We're Here to Help

Prefer to hand in paper, or need a hand? Reach out anytime.
Priority Wellness Care · 123 Gilmer Rd Ste 3 · Longview, TX 75604
Call: 903-757-3785  ·  Fax: 903-757-9390
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