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Georgia Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • Important:  these forms can be filled out online.  The form fields can be typed from your computer.  These are the easiest steps to follow to complete this process:

  • If you do not already have AdobeReader® installed on your computer, click HERE to download.
  • Open the form by clicking on the link,
  • Fill in all appropriate fields on each required form,
  • Save the form to your computer and name it the following:  "Your First Name Your Last Name, Date of Your Appointment, Name of the Form",
  • Email that form to our office:  georgiachirostl@gmail.com, and be sure to include your name in the subject line of the email,
  • Done.
  • If you do not want to fill the required forms out online and email them, then please simply print them, and either fax the the completed forms in before your appointment:  636-272-6995,  or bring them with you on the first appointment.

New Patient Health History Form - Required

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!

Health History


Health Information Privacy Form - Required

Please Print, Read, and Sign

Download & Print Form


Consent to Treat a Minor - Required            In The Following Instances:

If your family member who is presenting for treatment is younger than 17, please print and bring in the following completed form:

Download & Print Form


Member Wellness Registration Form - Optional

This form can be filled out online to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. 

Click Here to register online!

The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!


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