Online Forms

Knight Chiropractic Center 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!

NEW PATIENT INTAKE FORM

WORK RELATED INJURY INTAKE FORM

AUTO INJURY INTAKE FORM 

   VERY IMPORTANT!!  

Please also choose below the appropriate pain chart

for your area of concern:

NECK / UPPER-BACK / ARM / HEADACHE – PAIN CHART
LOW BACK / HIP / LEG – PAIN CHART 

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

What is HIPPA? ...It is the Health Insurance Privacy & Protection Act.
It is a signed agreement between you and our Chiropractic Center obligating us to protect your information.  We will only share information with your doctors and the loved ones you list on your form.

Federal laws called HIPPA mandate criteria for us to follow in order to protect your personal information. We at Knight Chiropractic Center, LLP follow the HIPPA Regulations as well as the following internal Privacy Policy to protect you.