Elmira Family Chiropractic offers our forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
Download the necessary form(s), print it out and fill in the required information. Bring these forms with you to your first appointment.
Download the Free Adobe Reader – if you do not already have it installed on your computer.
Please fill these out as thoroughly as possible. Doing so will help the doctor to best determine how to help you. Please, to save time, also being with you any other test results that you believe may be relevant to your case.
Adult (13 and older) – New Patient Health History Form
Download & Print Adult Intake Form (Age 14+)
Child (under 12) – New Patient Health History Form
Download & Print Child Intake Form (Age 0-13)
Pregnancy – New Patient Health History Form