Bender Chiropractic Health & Vitality 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 — Chiropractic
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 Adult History Form
Download & Print Child History Form
Download and Print Electronic Health Record
Download and Print Informed Consent to Care
Download and Print Notice of Privacy Practices and Authorization Form