Patient Forms

Upon entering our office, you will  be warmly welcomed by the front desk attendant.  We will request that you complete our patient forms, which can also be completed prior to coming into the clinic. This paperwork provides us with your health history and information on your condition.​

Please fill out the "About the Patient form" below

Also, please fill out the appropriate form below (child form for kids 12 and under)


Next, you will have a consultation with one of our doctors to discuss your health-related problems, concerns and potential treatment options. This initial visit is designed for the doctors to learn more about you, your condition and your expectations to determine how chiropractic care can meet your goals.


After your consultation, the doctors will perform a complete chiropractic exam, which will include, but is not limited to, an orthopedic exam, reflex and muscle testing, and an Insight Subluxation Scan. Other standard neurological, postural and physical tests will be performed as well. However, nothing  will be done in our office  without your consent.

Report of Findings

Once the information is collected  and examinations are performed, the doctor will give you a detailed report of all findings and answer any questions, including: 

How can you help me?
How often do I need to come in?
What  will  my treatment  cost?

After reviewing your health history,  goals and examining your spine, the doctor will discuss recommendations and notify you if  your condition  requires care with other providers.  Dr. Brittany Mulder and Dr. Madalyn Raasch  will  provide the best  treatment and  wellness program for your needs.


At the conclusion of this initial  appointment, you can choose to  experience your first treatment. This may include spinal adjustments and soft tissue techniques.  Treatment is interactive, so  you can express concerns about the different styles of treatment  anytime.

Payment Options

Empower Chiropractic will gladly check on your chiropractic benefits with the insurance company you or your family utilizes.  We also offer affordable cash plans and family plans for our patients who choose to pay per visit.  Please call to discuss your options.


To learn more about what your insurance company may contribute for your care, call them directly and ask for chiropractic benefits.  Our staff will verify and explain your benefits before treatment — at no charge.  We accept auto accident, workers compensation and personal injury cases.  Since there are so many plans and coverage varies widely, please call us to find out if your plan covers care in our office.

No Insurance

Our goal at Empower Chiropractic and Wellness Center is to allow each individual to experience the benefits of chiropractic care. For patients who have little or no chiropractic insurance coverage, we can work with you to arrange a flexible payment program that fits your budget.

If you have no insurance or if your insurance does not have any chiropractic benefits, there are still ways for you to receive chiropractic care.  Many patients choose to pay directly for their visits with the chiropractor, especially as they discover that chiropractic care is actually extremely cost-effective and affordable.  For these patients, chiropractic care is often cheaper and more effective than alternative pain treatments such as pain medications or invasive surgery.​

What to Expect at your first Visit


New Patient Information, Forms & Payment Options

  • Pediatric Chiropractic
  • Why chiropractic works
  • Wellness strategies
  • Disc Herniation
  • Numbness/ Tingling
  • Fighting migraines
  • Dealing with fatigue
  • Diet and Detox
  1. Nagging neck pain
  2. Dealing with fatigue
  3. Adjustments in Children
  4. Boosting the Immune System