Patient Forms

From Dr. Cowan: The importance of these forms

The clinical nutrition program at Acupuncture and Chiropractic Center of Pensacola has gone through a major renovation over the last 10 years. During my Clinical Nutrition Studies to become a Diplomate in Clinical Nutrition, it became quite evident to me the importance of gaining information for every facet of your health history.

From your standpoint, you present with a health problem you hope will be solved with a natural approach without the use of medications or their side effects. From my side of it as a health detective, I have realized that I can’t leave any stone unturned.

The complexity of your life does not always equate into a simple solution, and it’s up to me to figure out why your health is not working optimally. The extensive health history form provides me that information and allows me to select those tests needed to gain further knowledge for possible resolution to your current health problems.

Your thoroughness to detail will assist me in evaluating your health concerns. If you are not completely honest when completing the forms, your recommended treatment may be less than expected. So please, fill them out as accurately as possible.

Here at Acupuncture and Chiropractic Center, our approach to your health concerns will be one of a holistic / functional medicine approach. This means:

  • Emphasis is placed on the identification of areas of imbalance or dysfunction in normal physiology.
  • Diagnosis will integrate data from many different systems and methods.
  • Your treatment addresses the underlying causes of dysfunction.
  • Our approach allows for an early prediction of dysfunction.

Your health is measured along a wellness continuum, which is a spectrum moving from health to disease. Intervention can be made at every stage of the spectrum to restore or improve health and wellness. We need your accurate, in-depth information to accomplish this goal. For acupuncture and chiropractic appointments, please download and fill out Form 1. For nutritional assessments, please download and fill out forms 2 through 6. All forms should be filled out prior to your appointment. 

Links to forms

1. Acupuncture and Chiropractic Form

2. Daily Record of Food Intake

3. Brain Function Assessment Form (BFAF)

4. Your Nutrition History

5. Metabolic Assessment Form (MAF)

6. Brain Health and Nutrition Assessment Form (BHNAF)


If you have any questions on your patient intake forms, please call our Pensacola acupuncture and chiropractic office. We will be happy to assist you.

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