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    • Resources
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Forms to fill out

For new patients seeing Dr. Chad or Dr. Keen for the first time, please fill out Confidential Patient Case History and bring with you. If child please fill out Pediatric History form.

Pediatric History Form (doc)Download
Accident Report (docx)Download
New patient case history BIC (doc)Download
New Patient case history BIC (pdf)Download

Wellness Check Questionnaire , if coming in for N.E.T

If you are seeing Dr. Chad for the N.E.T - Neuro Emotional Technique treatment, please fill out the following questionnaire first.

Questionnaire

Aid Stress Tool (FAST) used with Neuro Emotional Technique

FAST can be used to help relieve symptoms associated with mind/body stress. FAST comes from a more comprehensive technique called call NET - Neuro Emotional Technique. Both FAST and NET are focused on eliminating specific conditioned response patterns so people don't have to keep experiencing a continual reaction to unresolved past events. In some cases NET, which is only used by licensed healthcare practitioners, is needed to help find and resolve the deeper issue associated with a past stress pattern.

NET FAST Self care (pdf)Download

STANDARD PROCESS 21 DAY CLEANSE

Patient-Purification-Program-Guide (pdf)

Download

Toxicity-Questionnaire (pdf)

Download

Purification-Recipe-Booklet (pdf)

Download

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Blaker Integrative Chiropractic LLC

120 Sister Pierre Dr. Suite 405 Towson, MD 21204 USA

(410) 823-2626

Copyright © 2019 Blaker Integrative Chiropractic L.L.C