Online Forms

Democko Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Please do not date any of these forms. We will do that when you come in for your appointment. There will be some additional paperwork depending upon what type of patient you are.

• 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 form(s) or bring it with you to your appointment.

This sheet gives us your personal information needed to input into our system such as name, address, contact information and insurance information. 

Download and Print Form 1

New Patient Health History Form - Required

This lets us know the history and current state of your health. This is a two sided form. Please make sure that you complete both sides and sign at the bottom.What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download and Print Page 1 History

Download and Print Page 2 History

Patient Consent Form - Required

This informs you that your records are confidential and we are NOT allowed to release them to anyone without your permission.

Download & Print Form #3

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!