Forms and Assessments - Specific Wellness

(248) 213-1332 | 6905 Telegraph Road Suite 119 Bloomfield Hills, MI 48301

Download your forms here, print them, complete them and bring them in on your next appointment or email them to: info@specificwellness.com

Stress Assessment

Intake Form

This form is needed for all of Dr. Stacey’s new patients or if you haven’t been seen in over a year

Health Appraisal Questionnaire (HAQ)

Detox Questionnaire

GI Questionnaire

Combined Massage Therapy Intake Forms

This form is needed to be completed before your first massage appointment.

Specific Wellness Dr. Stacey Francis

6905 Telegraph Road # 119, Bloomfield Hills

5.0 56 reviews

Jake Atchoo ★★★★★ 2 weeks ago
Dr. Stacey has completely changed my life for the better. She is a true expert in her field. I’ve seen results in my energy and overall well being in a very short period of time and have already recommended her to everyone in my network. … More She’s incredible!
Yaf Rab ★★★★★ a month ago
Stacy has been so helpful in so many areas with our family. We are deeply grateful for her help
Dzvinka Hayda ★★★★★ 2 months ago
Very professional and helpful with information and tecommendations pertinent to one's issues.
Vaughn Walker ★★★★★ 4 months ago
Dr. Francis is great. She's always addressing my concerns. Even when I come with many. Go into your appointments with an open mind and you won't regret it!
Tia Chavis ★★★★★ 5 months ago
Dr. Stacey took the time to discuss what I was experiencing. I felt supported and cared for. I'm so thankful to have her guide me on my journey to wellness.
Cassie Sobelton ★★★★★ 7 months ago
Dr. Stacey Francis is a fantastic chiropractor & so pleasant to be around. I highly recommend her.
Hind Patros ★★★★★ 7 months ago
I went in for an adjustment, due to waking up with a severe headache this morning, and just like that, my headache was gone! Thank you Dr. Stacey!!
Maureen Sullivan ★★★★★ 7 months ago
Was awarded a last minute appointment when I sorely needed it and left ready to make a 4 hour drive. Thanks and Go Dr Stacey and thanks for your help and support. Sincerely, Maureen
Michael Saunders ★★★★★ 9 months ago
23 years ago I hurt my back playing basketball, a friend recommended I see Dr. Francis. That visit was and continues to be a life changing decision. She not only corrected my back problem but also fixed other annoying pains. Even though … More I relocated to other cities, I still made my way back to Michigan to see Dr. Francis. No matter the problem, she always has a gentle healing solution. My wife and I have recommended her to many family and friends because she's truly AMAZING!
Carolina Velazquez ★★★★★ 9 months ago
Dr. Francis is absolutely amazing!!! I came to her with, what I thought were so many issues and she was able to help me with them all! She took her time to hear me out during out initial consultation and I am beyond happy with my results! … More I was dealing with pre-menopausal symtoms such as weight gain and night sweats and she immediately put me on an eating plan and supplement plan that not only helped me lose 11 pounds, but reduced the night sweats within a month. She is so much more than just a chiropractor, she really wants to help get to the bottom of whatever is bothering you by examining you as a whole. She is one of the most amazing people and she just makes me smile when I see her. Go see Dr. FRANCIS RIGHT NOW!!! You won't regret it!
Molly F ★★★★★ 9 months ago
Before seeing Dr. Francis, I had stomach aches every day, painful eczema, headaches, and terrible allergies. After one visit, she figured out I had an inflammation issue in my GI system. She created a plan for me and after a few diet changes, … More I already felt so much better. My stomach aches went away almost immediately, and it will take longer for my eczema to clear up, but it has already been a lot better. I had seen some doctors before for all my issues and I never got a good solution. I also never thought they were all related. I am so grateful for Dr. Francis and how she has turned my health around for me!
Greg Gelow ★★★★★ 10 months ago
I tried Dr. Francis on a recommendation from a friend. I had been using another Doctor with limited results and needed a new approach. Dr Francis took the time to review my condition, perform an adjustment and make specific recommendations … More to help me get better faster. Its been only one day and I feel better already with a lot less pain and have been following the Doctors orders. I go back in a couple of days for more evaluation and adjustments. I would recommend Dr. Francis just because one visit and I feel better, wish I was here two weeks ago getting help.
Menucha Polter ★★★★★ 11 months ago
I was suffering from insomnia, and exhaustion. My knees hurt which I tried physical therapy for and did not work. With a change in my diet and supplements, my sleep and energy levels are amazing. And with a few adjustments my knee pain … More is gone! Dr. Stacey Francis deals with the issue, the real one. I’m so grateful 🙏🏼
Greg Ervin ★★★★★ a year ago
Have known Dr. Francis for over 15 yrs. She is well trained and educated. I would refer anyone to her needing a adjustment and holistic care. She will find a way to help you.