INTAKE FORM- AGES (4 - 17 YEARS)

FALLS HEALING ARTS
Intake Age 4-17 Form

Please fill out and submit prior to your first appointment. 

If you haven't already, give us a call to schedule your first appointment. 

(By submitting an intake form online without calling us,

does not guarantee the fastest response back to you for scheduling.) 

The information on these forms help our doctors and therapists determine what course of treatment to pursue. Chiropractic patients are asked to also bring their insurance card.

Dr. Craig Stefanczyk — Licensed Chiropractor in Sheboygan Falls, WI

Dr. Craig Stefanczyk

Dr. Craig grew up in suburban Milwaukee and graduated from Whitefish Bay High School in 1982. He obtained his undergraduate degree from Westminster College in Fulton, Missouri and went on to obtain a Bachelor of Science degree and Doctor of Chiropractic degree from the National University of Health Sciences in Illinois. 

Doctor Stefanczyk opened his office in Sheboygan Falls in October of 1990, and moved into the current facility in 2002. He, along with his wife Joni and four children, has lived in Kohler since 1991. Dr. Stefanczyk is an avid fisherman and also enjoys basketball and woodworking.

FALLS HEALING ARTS, S.C. Intake Age 4-17

1.PATIENT INFORMATION 

IN CASE OF EMERGENCY, CONTACT

2. INSURANCE INFORMATION

3. ACCIDENT INFORMATION

4. PATIENT CONDITION

6. Injuries/surgeries your child has had

Person Ultimately Responsible For Account

We invite you to discuss frankly with us any questions regarding our services. The best health services are based on a friendly, mutual understanding between provider, parent and patient.


Our office policy requires payment in full for all services at the time of visit. The person bringing the patient to this office is responsible

for charges unless other arrangements have been made with the business manager. If the account is not paid within 90 days of the date of service, and no financial arrangements have been made, you will be responsible for any expenses incurred in collecting your account.


I understand the above information, guarantee this form was completed correctly to the best of my knowledge and understand it is my responsibility to inform the office of any changes in my child’s medical status.

Dr. Andy Woodas — Licensed Chiropractor in Sheboygan Falls, WI

Dr. Andy Woodas

Dr. Andy received his doctor of chiropractic from Palmer College of Chiropractic in 1997. The techniques he utilizes include: Diversified, Gonstead, Thompson, Activator, and Cox flexion-distraction. He is committed to helping families in the community experience improved health and vitality. Dr. Andy enjoys educating others on how to manage stress better, how to prevent injury in the workplace and at home, and how to maintain peak performance. Dr Woodas genuinely cares about every one of his patients and takes pride in treating the person, not just the symptom. 

A resident of Plymouth, he enjoys reading, camping, sports, and spending time with his family. Dr Andy has been practicing at Falls Healing Arts since 2012.
Michael Nauschultz — Licensed Chiropractor in Sheboygan Falls, WI

Michael Nauschultz

Michael graduated from Blue Sky Educational Foundation of Grafton, WI in 2001, and joined Falls Healing Arts the same year. Michael is a licensed massage therapist specializing in integrative neuromuscular therapy and sports massage. He is also skilled in relaxation massage, lymphatic massage, and reflexology. Michael believes massage is not only for healing but for education. He likes to help his clients learn how to recognize and break their pain patterns. 

A U.S.Navy veteran, Michael lives in Sheboygan with his wife and is interested in traveling, photography, and volleyball.
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