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Smith 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), 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.

New Patient Health History Form - Required

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!

Download & Print Form


Electronic Health Records Intake Form - Required

In compliance with the requirements for the government EHR program

Download & Print Form


HIPAA Form - Required 

For use and/ or disclosure of protected health information to carry out treatment , payment and other healthcare operations.

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!

Download & Print Form



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Office Hours

DayMorningAfternoon
Monday9am - 1pm3pm -7pm
Tuesday9am - 1pm3pm -7pm
Wednesday3pm -7pm
Thursday9am - 1pm3pm -7pm
Friday9am - 1pm
SaturdayClosed
SundayClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9am - 1pm 9am - 1pm 9am - 1pm 9am - 1pm Closed Closed
3pm -7pm 3pm -7pm 3pm -7pm 3pm -7pm