Online Forms

Online forms

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Fort Myers Chiropractic Studio

are a New Patient?

If you are a New Patient to our office, you’ll need to fill out your Health History. You can print the form and fill it out by hand, or you can download the form, and fill it out using your computer screen and keyboard, then print out the completed form. You’ll have to initial and sign where indicated after the form is printed. Then just bring in the completed for with you to your first appointment.


You will also need to read and sign our Financial Policy and HIPAA Consent form. Just print these forms, then sign and date it and bring it in with you to your appointment. Please note that there are 2 pages to the Financial Policy. By Law medical offices are required to take a copy of patient’s photo ID. We will copy your photo ID onto this second page when you come in for your appointment.


To read our entire HIPPA policy, click here. 

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