Online Forms

Germantown Chiropractic & Wellness 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 Intake Form

Pediatric Member App

Consent to Treatment of Minor

HIPPA

Neck Pain Questionnaire

Lower Back Pain Questionnaire

Headache Disability Form

Upper Extremity Questionnaire

Lower Extremity Questionnaire

New Patients Receive a Free Consultation.

Office Hours

Our Regular Schedule

Monday:

8am - 12pm

3pm - 6:30pm

Tuesday:

Closed

3pm - 6:30pm

Wednesday:

8am - 12pm

3pm - 6:30pm

Thursday:

8am - 12pm

3pm - 6:30pm

Friday:

By Appt.

Saturday:

Closed

Closed

Sunday:

Closed

Closed

Locations

Find us on the map