PATIENT RESOURCE CENTER

Democko Chiropractic offers our patient form(s) online so you may complete the forms in the convenience of your own home or office.

Required Patient Forms

Thumbnail 220x PDF
New Patient Information Welcome Sheet -Required
This sheet gives us your personal information needed to input into our system such as name, address, contact information and insurance information.

New Patient Health History Form - Required
This lets us know the history and current state of your health. This is a two sided form for both sides. Please make sure that you complete both sides and sign at the bottom.What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Patient Consent Form - Required
This informs you that your records are confidential and we are NOT allowed to release them to anyone without your permission.

Download "Democko_New_patient_paperwork.pdf"

Upon entering our office, our receptionist will  welcome you as a member of our family.  We will request that you complete our  patient forms located in the New Patient Center. This paperwork provides us with your health history and information on your condition.
  • 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.
ALSO, IF YOU ARE CURRENTLY TAKING ANY MEDICATIONS (PRESCRIPTION AND/OR OVER THE COUNTER) PLEASE BRING A LIST OF THOSE.

Please do not date any of these forms. We will do that when you come in for your appointment. There will be some additional paperwork depending upon what type of patient you are.

Schedule An Appointment

We are welcoming new patients and look forward to hearing from you!
Spam Protector: Please answer the question below.
*