Online Admitting Paperwork

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms.


Health History

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?

0-2 Month History

 Download & Print Form

2 Month-2 Year History

 Download & Print Form

2-5 Year History 

 Download & Print Form

Adult History

 Download & Print Form




Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.




Dr. Sam Hallows DC | 7436 E Main St, Suite 1, Mesa, AZ | (480) 830-0175
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