Online Forms

University 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) relevant to you, 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.

Health Insurance Portability and Accountability Act (HIPAA) - Required

This form explains our standards of care to protect the privacy of your information. At the same time, the Privacy Rule permits the disclosure of personal health information needed for patient care and other important purposes. 

Download & Print Form

New Patient Health History Form - General

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!

New Patient Health History Form - Auto Accident  

If you are seeking treatment due to an automobile accident, please complete the following form

Download & Print Form

 New Patient Health History Form - Work Injury 

If you are seeking treatment due to a work injury, please complete the following form

Download & Print Form

Children Health History Forms 

If you are seeking care for your child (under 18 years old), please complete the following form

Download & Print Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!