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In order to provide your child with the best possible care, please complete this form in detail.

Child's Information

Contact Information

How can we serve you?

Subluxations (spinal misalignments) cause most of the unwanted health conditions people suffer from every day. Subluxations affect your nervous system, which affect your health.

Has your child ever:

Please check all that apply.

Family History

Please identify how your child's current conditions are affecting their ability to carry out activities that are routinely part of their life.

Medical History

Please select the number that best indicates the level of pain you are experiencing. Please rate only the problem that bothers you the most.

Thank you for submitting your form online, we look forward to serving you!

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THIS ---->https://healthyknox.com/online-forms/children-s-health-history.html

Office Hours

Saturday*9-11am by appt only
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:30-12pm 9:30-12pm Closed *9-11am by appt only Closed
3-6pm 3-6pm 3-6pm 3-6pm
* Click HERE to see Saturday Hours.


have been so pleased with meeting Scoles Family Chiropractic. I feel so good every time I go. I can tell them where I have an issue and they fix me. Thank you so much Dr. Andy and Dr.Jennifer.

Melanie N.
Knoxville, TN

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