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Online Forms

Pointe Village Chiropractic offers our patient forms online so they can be completed at your convenience prior to your appointment.

  • 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.
  • All new patients and returning patients must fill out the new patient questionnaire, neck pain scale and Owestry, terms of acceptance and consent for treatment. In addition, those involved in a motor vehicle accident please complete the motor vehicle accident questionnaire. For those involved in a work injury, please fill out the Work related injury questionnaire.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Questionnaire
Download & Print Form


Motor Vehicle Accident Questionnaire
Download and Print Form


Work Related Injury Questionnaire
Download and Print Form


Consent for Treatment
Download and Print Form


Terms of Acceptance
Download and Print Form


HIPPA Notice of Privacy Practices
Download & Print Form


Functional Rating Index
Download & Print Form



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Contact Us

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Locations

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Office Hours

Our Regular Schedule

Office Hours

Monday:

9:00 am-7:00 pm

Tuesday:

3:00 pm-7:00 pm

Wednesday:

9:00 am-7:00 pm

Thursday:

Closed

Friday:

9:00 am-7:00 pm

Saturday:

8:00 am-11:00 am

Sunday:

Closed