Patient Forms

We offer our patient forms online so they can be completed in the convenience of your own home or office before you arrive for 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.
  • Fax us your printed and completed forms at (973) 628-0847 or bring it with you to your appointment.


New Patient Intake Form

Health History Form

HIPAA Form

Medical Release Form

Chiropractic Care Consent Form

Verification Of Coverage

Contact Us Today!

We look forward to hearing from you.

Our Location

159 Newark Pompton Turnpike | Pequannock, NJ 07440-1300

Office Hours

Our General Schedule

Chiropractic Hours

Monday:

8:00 am-12:00 pm

2:00 pm-7:00 pm

Tuesday:

8:00 am-12:00 pm

Wednesday:

8:00 am-12:00 pm

2:00 pm-7:00 pm

Thursday:

Closed

Friday:

8:00 am-12:00 pm

2:30 pm-7:00 pm

Saturday:

8:30 am-12:00 pm

Sunday:

Closed

Acupuncture Hours

Monday:

8:00 am-12:00 pm

2:00 pm-7:00 pm

Tuesday:

Closed

Wednesday:

8:00 am-12:00 pm

2:00 pm-7:00 pm

Thursday:

8:00 am-1:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed