Patient Forms – Smith Chiropractic

Smith Chiropractic offers our patient forms online so you can complete them in the convenience of your own home or office.

Download the necessary forms, then print them out to complete.
Fax us your printed and completed forms or bring them with you to your appointment. Our fax number is 908‑464‑0199.
Please bring your insurance card (if applicable) and driver’s license on your initial visit.

Forms

New Patient Health History Form including payment policies and procedures

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Please, let us know!
Wellness Made Affordable

Our in-house payment program is designed as an affordable option for those who choose not to go through their insurance plan.
Agreement for Electronic Communication

Are you OK with us sending you a text reminder of your upcoming appointment? How about an occasional email highlighting one of Dr. Smith’s wellness tips? Please print, sign and let us know either way.
HIPPA Documentation

What Our Patients Say

Paul G.

auto accident

“I was not a stranger to chiropractic; I had seen two or three doctors previous to the accident. But it was at this time that I had the great good fortune to meet and be treated by Dr. Patrick Smith. Dr. Smith is an extraordinary diagnostician and superb practitioner of his science and art. As pain and stiffness worsened Pat developed a course of treatment that was, and is, most effective in keeping me mobile, flexible and almost, but not entirely, pain free.”

Kay L.

shoulder replacement

“Treatment at Smith Chiropractic has been unerringly professional, kind and so highly intelligent that my 40 years of hospital work has led me to make Smith Chiropractic my first stop whenever I need to consider surgery or medical care or make medical decisions.”

Cindi P. (parent)

sports injuries

“Dr. Smith has treated many of my children's injuries from recovery after broken bones, shoulder tendonitis, pinched nerves, hip flexor problems, and a torn calf muscle. His deep knowledge of how to treat athletes has allowed them to play through their injuries, rather than taking a significant amount of time off from their sport, along with his ability to understand and quickly diagnose a problem, in my opinion, has prevented more severe issues. ”