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Pointe Village Chiropractic offers our patient forms online so they can be completed 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, neck pain scale and Owestry, 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 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

Work Related Injury Questionnaire
Download and Print Form

Consent for Treatment
Download and Print Form

Terms of Acceptance
Download and Print Form

HIPPA Notice of Privacy Practices
Download & Print Form

Functional Rating Index
Download & Print Form

Member Wellness Registration Form - Optional

This form can be filled out 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. You can print it out and bring it in to our office or 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!

Download & Print Form

Download the Free AdobeReader

Welcome to Pointe Village Chiropractic


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THIS ---->https://pointevillagechiropractic.chiromatrixbase.com/new-patient-center/online-forms.html

Office Hours

Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00am 3:00pm 9:00am Closed 9:00am 8:00am Closed
7:00pm 7:00pm 7:00pm Closed 7:00pm 11:00am Closed

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