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, and goals regarding wellness can we help you with?
Let us know!
Download and Print: Adult History Form
Download and 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
