Accessibility View Close toolbar

EXCLUSIVE OFFER, NEW PATIENTS RECEIVE FREE CONSULTATION.

Online Forms

Belcher Family Chiropractic LLC. offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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




Disclosure of Fees
Privacy Notice Agreement
Informed Consent 
Assignment of Payment


Download the Free AdobeReader®