Pain Relief & Wellness Care: Call (732) 383-5410

Chiropractic and NutritionOur office provides chiropractic with simple procedures and objective nutritional solutions based on your blood test. Call or visit:
776 Shrewsbury Avenue Suite 206, Tinton Falls, NJ 07724

The Center for Wellness
   with Dr Philip Agrios

Make Your Switch To Optimal Health and Feel Your Best Permanently!

 

Patient Intake Forms

We offer our New Patient Intake Forms online so you can complete them in the convenience of your own home. Please fax or email them FULLY completed. Please read the instructions thoroughly. Email forms to This email address is being protected from spambots. You need JavaScript enabled to view it. or fax them to 732-676-7777.

New Patient Intake Forms Package


Download these forms for all injuries except for motor vehicle and fall down accidents.  We are very thorough so please fill out all forms to the best of your knowledge.  If you have any questions, email us your questions or call us at (732) 383-5410 and we will be happy to answer all of your questions.

Motor Vehicle Accident / Fall Down New Patient Intake Forms Package


If your health issue is the result of a motor vehicle accident or you have a lawsuit due to a fall down injury, then please click on the forms below. We are very thorough so please fill out all forms to the best of your knowledge.  If you have any questions, email us your questions or call us at (732) 383-5410 and we will be happy to answer all of your questions.

IMPORTANT! You will not be seen unless you have these forms with you at the time of visit. Thank you for understanding.

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

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Now Accepting New Patients

We will provide you with a comprehensive and personal health analysis to determine whether you need Chiropractic care, blood-based nutritional recommendations, or a combintaion of both. Contact us today to learn more.