New Patient Paperwork

Synergy Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

All forms are PDF files. You will need AdobeReader® to view them.
If you do not already have AdobeReader® installed on your computer, Click Here to download.
Download the necessary form(s), print them out and fill in the required information.
Fax us your printed and completed form(s) or bring them with you to your appointment.

If you are a new client, please complete the following forms and bring them to your first therapy session.

New Chiropractic Patient Paperwork - Click to Download

Pediatric Intake Form - Click to Complete

Neurofeedback Intake - Click to Download

Adult Self Report Scale Symptom Checklist - Click to Download

Child Report Scale Symptom Checklist - Click to Download

Limits of Confidentiality / Cancellation Policy - Click to Download

Terms of Acceptance - Click to Download

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization to Disclose Information Form - Click to Download