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Harmony Chiropractor Center, Inc offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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 Form - Required

This lets us know the history and current state of your health. This form will be used as part of your history and exam. Let us know if there are  any questions, concerns, goals, regarding wellness that we can we help you with.

If your main problem is a musculoskeletal or pain complaint, please download and print the following form.

New Patient Form - Pain

If you (or the patient) have a neurological complaint like Vertigo, ADHD, Dyslexia or Post-Concussion Syndrome, then please download and print the following form.

New Patient Form - Neuro


Other Forms - Optional

If you have Neck Pain, please fill out this additional form.
If you have Headaches, please fill out this additional form.
If you have Low Back Pain, please fill out this additional form.
If you have Shoulder Pain, please fill out this additional form.
If you have Knee Pain, please fill out this additional form.
If you were involved in a Motor Vehicle Collision, please fill out this additional form.
If you were involved in a Worker's Compensation Claim, please fill out this additional form.


Female Health History Questionnaire

Please let the Doctor know if you have any concerns and we will provide you with the Female Health History Questionnaire.


Notice of Privacy Policy Form

This is included in the new patient forms, but if you want to print a copy for your records you may do so below.

Download & Print Form


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