Intake Forms

before your first visit with Dr. Pearce, Click the link(s) below to download and Print your paperwork. 

Fill it Out and bring to your appointment. This can save you time, however, Paperwork can also be completed upon arrival.

NUTRITION RESPONSE TESTING

• Consultation / New Patient Packet (1st Visit)
• Symptom Survey Form (1st Visit)
• Daily Record of Food Intake (Reference)

CHIROPRACTIC Patients

• Patient Basic Information Packet
• Patient Health Questionnaire

Injured in a car accident? Please fill out these additional forms:

• Auto Accident Packet

You can send the completed form(s) to us in one of two ways.

1. The form can be faxed to: 903-757-9390
2. Bring it to: Priority Wellness Care 123 Gilmer Rd Ste 3 Longview, TX 75604