Mills Chiropractic 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! Each practice member needs to complete a Case history, Emergency contact form, HIPAA Privacy form, Payment Policy, Terms of Acceptance.
Clients 12 & Under Complete Pediatric History Form
Clients under 18 Complete Minor Consent Form
Download & Print Terms of Acceptance Form
Download & Print Payment Policy Form
Download & Print Emergency Contact Form
Download & Print HIPAA PrivacyForm
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 chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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 FormDownload the Free AdobeReader®
| Mon | 8 - 12 | 2 - 7 |
| Tue | Closed | 2 - 6 |
| Wed | 8 - 12 | 2 - 7 |
| Thu | Closed | 2 - 6 |
| Fri | 8 - 12 | 2 - 7 |
| Sat | 9 - 12 | Closed |
| Sun | Closed | Closed |
Call Us:
724-548-7999 Request
Appt.
3D Spine Simulator
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