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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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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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January Newsletter: Natural Pain Relief: How Chiropractic Can Help Your Back Pain

Not sure what to do about back pain? Give your chiropractor a call. ...

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December Newsletter: How Wearing High-Heeled Shoes Can Lead to Scoliosis

Could wearing high heels lead to a painful back condition? ...

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December Newsletter: Chiropractic Care for Hip Pain

Got nagging hip pain? Chiropractic care could help. ...

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November Newsletter: Tips for Chiropractic Adjustment Aftercare

Do you know how to take care of your body after a chiropractic adjustment? ...

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November Newsletter: How Chiropractic Care Can Help Runners

Frustrated by running injuries or pain? Chiropractic care can help. ...

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October Newsletter: Can Chiropractic Care Help with Digestive Disorders?

Could chiropractic care offer the solution to your digestive problems? ...

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October Newsletter: Chiropractic Care to Improve Workplace Ergonomics

Could chiropractic care and ergonomics be the keys to easing your work-related aches and pains? ...

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