Online Forms

Origin Spine and Wellness offers our patient form(s) online so they can be completed in the convenience of your own home or office.

If you do not already have AdobeReader® installed on your computer, click here to download.
Download the necessary form(s), print it out and fill in the required information.
Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

Download the Free Adobe Reader®

Name

Phone

Comments

Please do not submit any Protected Health Information (PHI).

Office hours & location

Monday

Closed

Tuesday

11:00 am - 5:30 pm

Wednesday

11:00 am - 5:30 pm

Thursday

11:00 am - 5:30 pm

Friday

11:00 am - 5:30 pm

Saturday

Closed

Sunday

Closed

Origin Spine and Wellness
671 S. Woodruff Ave,
Idaho Falls, ID 83401

208-552-2584

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Applied Kinesiology, NET, and Functional Medicine for unresolved pain and chronic illness in Southeast Idaho.

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OUR LOCATION

Origin Spine and Wellness
Dr. Rick Murphy, DC, PAK, CFMP
671 S. Woodruff Ave
Idaho Falls, ID 83401

208-552-2584