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Patient Forms

Pointe Village Chiropractic offers our patient forms online so you have the option of completing 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, 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 or Email 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


Consent for Treatment
Download and Print Form


Terms of Acceptance
Download and Print Form


HIPAA Notice of Privacy Practices
Download & Print Form


Our Location

20742 Hall Rd (at Heydenreich) | Clinton Township, MI 48038

Office Hours

The office will be CLOSED: Saturday, May 26th thru Monday, May 28th Have a safe Memorial Weekend!

Monday:

9:00 am-1:00 pm

3:00 pm-7:00 pm

Tuesday:

AM by Appointment Only

3:00 pm-7:00 pm

Wednesday:

9:00 am-1:00 pm

3:00 pm-7:00 pm

Thursday:

Closed

Friday:

9:00 am-1:00 pm

3:00 pm-7:00 pm

Saturday:

8:00 am-11:00 am

Sunday:

Closed

Contact Us Today!

We look forward to hearing from you.