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Billing Department

Exclusive Offer, New Patients receive a Free Consultation.

New Patient Forms

Structure & Function Chiropractic and Rehab 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.

Please take a moment to print and fill out the following forms to bring with you to your first appointment. Auto accident injuries please click here for the appropriate first visit patient intake form.

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!

Click to Fill Out Form

Download the Free AdobeReader®