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Online Chiropractic New Patient Forms

Quick & E-Z Patient Forms

El Paso Team Chiropractors

Welcome to our 4 E-Z Patient Intake Registration Forms. The information you fill in will be sent directly to our office, speeding up your initial office visit. I have also have added a fourth Institue Functional Medicine Detailed Online Intake Form for those seeking assistance and treatment with chronic degenerative conditions. Also, do share these links with those who need immediate care. Again, I welcome you to our office. God Bless & Great Regards:

Dr. Alex Jimenez 👊🏽



El Paso Chiropractor Become a Patient

👈🏽 Access your Personal New Patient Intake Registration Form. Also, do share 💯% this page with someone needing immediate care. 

✔️ Online Registration – #1

Our Quick n’ Easy Secured Online ☁️ Access Registration Form is available in order to expedite the initial new patient intake process.

🔴 Online Link: #1


✔️  Printable Registration – #2

Below you can generate an optional printable version of your Patient Intake form if you prefer not to fill out your form via the web or iPad.

🔵 Printable Version Link: #2


✔️Printable Registration: Personal Injuries #3

Note: Injured due to a Personal Injury 🚑 ? Use this optional printable version. Most injury cases have unique circumstances that require additional information. This form allows for important and specific details to be documented properly for your providers.

⚫️ Injuries Only Version Link: #3


✔️ Online Functional Medicine Registration #4

Note: Functional Medicine* and it’s thorough approach to treatment requires a detailed history and assessment. Our providers will assess your personal clinical data with an additional functional medicine approach. Our goal will be to find the true causes of your chronic conditions and to treat you with an in-depth holistic approach. Your information will securely be sent to a functional medicine specialist that will discuss your issues in detail. Our format and clinical questionnaire follow the most stringent Institute of Functional Medicine Mandates. Learn More

🍎 #4 NEW – Institute of Functional Medicine Assessment

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Dr. Alexander Jimenez ♛
Chiropractor & Functional Medicine Practitioner ⚕Injury & Sciatica Specialist • Author • Educator • 915-850-0900 📞
We Welcome You 👊🏻. Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive, cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, practical strength training, and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries. We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training and Rehabilitation Systems for all ages. As an extension to effective rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high-performance exercises and advanced agility treatment options. We have teamed up with the cities premier doctors, therapist and trainers to provide high-level competitive athletes the possibilities to push themselves to their highest abilities within our facilities. We’ve been blessed to use our methods with thousands of El Pasoans over the last three decades allowing us to restore our patients’ health and fitness while implementing researched non-surgical methods and functional wellness programs. Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, un-wanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, a positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living. With a bit of work, we can achieve optimal health together, no matter the age or disability. Join us in improving your health for you and your family. It’s all about: LIVING, LOVING & MATTERING! 🍎 Welcome & God Bless EL PASO LOCATIONS Central: 6440 Gateway East, Ste B Phone: 915-850-0900 East Side: 11860 Vista Del Sol, Ste 128 Phone: 915-412-6677