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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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