Online Forms

Smith Chiropractic offers our patient form(s) online so they can be completed it 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


Electronic Health Records Intake Form - Required

In compliance with the requirements for the government EHR program

Download & Print Form


HIPAA Form - Required

For use and/ or disclosure of protected health information to carry out treatment , payment and other healthcare operations.

Download & Print Form



Download the Free AdobeReader®

Contact Us Today

We look forward to hearing from you

Location

Find us on the map

Office Hours

Our Regular Schedule

Smith Chiropractic

Monday:

9:00 am-1:00 pm

3:00 pm-6:00 pm

Tuesday:

9:00 am-1:00 pm

3:00 pm-6:00 pm

Wednesday:

3:00 pm-6:00 pm

Thursday:

9:00 am-1:00 pm

3:00 pm-6:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed