Online Forms

Home » NEW PATIENTS » Online Forms
Online Forms2019-01-04T16:11:06+00:00

Hafkey Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or 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 Forms – Required for Patients

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!

Download & Print Form


Consent to Treat Minor Form – Required from Parents for Minors

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!

Download & Print Form


Automobile Accident Form – Required for auto accident related injuries

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!

Download & Print Form


Patient Progress Form

Download & Print Form


Download the Free AdobeReader®

  • Request Appointment

    Please complete the form to request an appointment. Please note you do not have an appointment until you receive confirmation from us.
    • This field is for validation purposes and should be left unchanged.