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Book Your Appointment

New Patient Info

New Patient

Our core strength lies in Michael’s mastery of motion palpation – accurately determining vertebrae positioning and unveiling the underlying source of symptoms. This skill sets the foundation for specific, lasting chiropractic adjustments. All new patients will go through a two appointment process. Taking the time to get to know and understand your pains, struggles and aspirations, the current functional state of your body, communicating the findings, and customizing a mutually agreed upon care plan, is essential. Clarity, working in partnership and following the same game plan, significantly enhances both the journey and the result.

Your First Appointment:
A Thorough Exam

Our patient onboarding process is designed to be thorough and thoughtful. Michael will review your health history, discuss symptoms, and perform a non-invasive functional exam to assess balance, posture, strength, and spinal integrity.

Please download and fill out this Patient Intake Form, and send the completed form in advance of your first appointment via WhatsApp +31640953724 or via email to info@nekwerk.nl. Jpeg or PDF is great.

Download Patient Intake Form English
Download Patient Intake Form Dutch

Your Second Appointment:
Review Findings, Customized Care Plan & Treatment

Michael will report his findings and recommendations. If Chiropractic and/or Pulsed Electromagnetic Fields will help you, he will propose a Customized Care Plan and your treatment will begin in this session.

Review Comprehensive Health Assessment and Custom Care Plan

Chiropractic Adjustment

Michael will perform Chiropractic treatment, and provide active daily life (ADL) guidance if needed.

“After years of visiting various chiropractors and osteopaths, Michael stands out as a top contender. Not only does he possess exceptional skills honed through years of practice, but he’s also genuinely compassionate and prioritizes patient well-being.”

Nat S.

NEKWERK Client

Ready to Elevate your
Health?

Book your Appointment
NEKWERK Patient Intake Form

NEKWERK

Patient Intake Form — Fill out carefully and in detail

A

Personal Information

Your basic contact and emergency details

Step 1 of 9
Emergency Contact Information
B

Referral

How did you hear about us?

Step 2 of 9
C

Health Insurance

Your insurance provider details

Step 3 of 9
D

Medical History

Please be as detailed as possible

Step 4 of 9
Michael Blackman Notes
Practitioner Only
E

Chiropractic-Specific Information

Details about your primary concern

Step 5 of 9
Michael Blackman Notes
Practitioner Only
F

PEMF-Specific Information

Pulsed Electromagnetic Field therapy

Step 6 of 9
Michael Blackman Notes
Practitioner Only
G

Fall Prevention Testing Information

Balance and mobility assessment

Step 7 of 9
Michael Blackman Notes
Practitioner Only
H

Lifestyle Information

Your daily habits and routines

Step 8 of 9
I

Patient Goals & Aspirations

Review your answers and submit

Step 9 of 9
Michael Blackman Notes
Practitioner Only
📧 Your completed form will be emailed to info@nekwerk.nl. Thank you — Michael Blackman looks forward to discussing your responses.
Your Summary
✅

Form Submitted!

Thank you for completing the NEKWERK Patient Intake Form.
Your information has been sent to info@nekwerk.nl.

Michael Blackman looks forward to discussing your responses.

Questions? WhatsApp +31 6 40 95 37 24
or email info@nekwerk.nl