Smithtown Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- Please complete the Online Forms and submit to our office
PATIENT HEALTH QUESTIONNAIRE
ASSIGNMENT & INSTRUCTION FOR DIRECT PAYMENT TO DOCTOR
RECEIPT OF NOTICE OF PRIVACY PRACTICES WRITTEN ACKNOWLEDGEMENT FORM
UNITED HEALTHCARE/NYSHIP PATIENT AUTHORIZATION FORMS
The forms below can be printed out at home and brought in on your first visit
- 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.
- Bring your completed forms with you to your appointment.
New Workers Compensation Patient Forms (for new patients who also have a workers comp injury)
New No Fault Patient Forms (for new patients who also have a no fault injury)
Nutrition New Patient Intake Form
Therapeutic Exercise History Form