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Online Forms

Daniels Family Chiropractic 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.

Please click below to fill out the Patient Intake Form and submit it online. (Make sure the form is completed in full by using any device except smartphones.)

Patient Intake Form

Please click below to download and print the HIPPA Form. (Complete this form and bring it with you at the time of your appointment)

HIPPA Form

Please click below to download and print the Financial Responsibility Form. (Complete this form and bring it with you at the time of your appointment)

Notification Of Financial Responsibility Form

Please click below to download and print the Informed Consent Form. (Complete this form and bring it with you at the time of your appointment)

Informed Consent Form



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Our Hours

Monday:

8:00 am-12:00 pm

2:00 pm-6:00 pm

Tuesday:

8:00 am-12:00 pm

2:00 pm-6:00 pm

Wednesday:

8:00 am-12:00 pm

2:00 pm-6:00 pm

Thursday:

Closed

Friday:

8:00 am-12:00 pm

2:00 pm-6:00 pm

Saturday:

8:00 am-10:00 am

Sunday:

Closed

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June Newsletter: Can Chiropractic Care Help with Neurological Conditions?

Need help managing a neurological condition? Try chiropractic care. ...

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May Newsletter: Does Chiropractic Care Improve Athletic Performance?

Frustrated by athletic setbacks? Chiropractic care could help you succeed. ...

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May Newsletter: Long-Term Benefits of Chiropractic Adjustments

Do you know about the long-term advantages of chiropractic care? ...

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April Newsletter: How Your Chiropractor Can Help with a Rotator Cuff Injury

Chiropractic treatment might be the answer to your rotator cuff pain. ...

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April Newsletter: How Therapeutic Exercises Can Help You Heal

Wish you could heal faster? Therapeutic exercises from your chiropractor could help. ...

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March Newsletter: Chiropractic Care for Neuropathy

Do you have neuropathy? Chiropractic could have the answer to your pain. ...

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March Newsletter: Chiropractic Care for Patellofemoral Pain Syndrome (Runner's Knee)

Struggling with runner's knee pain? Chiropractic care can ease your kneecap pain. ...

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February Newsletter: Chiropractic Care for Fibromyalgia

Chiropractic care might be the answer to your fibromyalgia pain. ...

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February Newsletter: How Your Chiropractor Can Help with Degenerative Disc Disease

Struggling with back or neck pain due to degenerative disc disease? A visit to the chiropractor could relieve your pain. ...

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