Baby Treatment Form

Please take the time to carefully fill out the medical history form. It is a very important basis for the first treatment of your child in our practice. If you do not wish to provide certain personal information in writing, you are free to do so. Your information will of course be treated confidentially and is subject to medical confidentiality.
Thank you very much, IHR-CHIROPRAKTOR Team
(Fields marked with * are required)

Details of the parents

Details of the child

During pregnancy


After birth until today

Behavior of your baby

Posture/motor skills of your baby


Data Protection * (more information)

Riskinformation / Risk disclosure * (more information)

Knowledge and conscience Headline *