Online Forms
Kimel Chiropractic Center, P.C offers our patient form(s) online so you can complete 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 Information Form and Privacy Notice - Required.
Inform us of your contact information and how you desired to be contacted. You will also be given the opportunity to sign up for our e-mail newsletter and gain access to the member only portion of this website. Lastly, this document contains information about our office policies which protect your personal and health information.
Download & Print FormNew Patient Case History Form - Required.
What is the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
New Child Patient Information and Privacy Notice - Required for a minor.
If your child is a minor please fill out this privacy notice to inform us of your contact information. You will also be given the opportunity to sign up for our e-mail newsletter and gain access to the member only portion of this website. Lastly, this document contains information about our office policies which protect your personal and health information.
New Child Case History Form - Required for a child 10 years old or younger.
Depending on the age of your child some of the questions may no longer be relevant as they are targeted to an infant. Please do your best at informing us of your childs past health history or concerns.
3D Spine Simulator
Launch 3D Spine Simulator