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The Spine and Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • 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.

New Patient Health History Form - Required

Filling out the online paperwork prior to your initial visit will save both yourself and our staff time.  To receive a User name and Password, please call the office at: 610-779-4588 to make an appointment. Click on the link below that pertains to the service(s) you are having rendered. If you are unable to fill out paperwork online, please print out forms and fill out prior to your appointment.

New Chiropractic Patients online paperwork

New Chiropractic Patients print forms

New/ Existing Patients with WORKER'S COMPENSATION

New/Existing Patients with AUTO ACCIDENT

New Massage Patients

New Acupuncture Patients

New Patient Facial

New Patient Personal Training

New Patient Laser Hair Removal

Consent to Treat a Minor

Medicare Insurance Chiropractic form

Gym Membership Application

Birthday Party Waiver

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

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Welcome to The Spine and Wellness Center!

THIS ---->https://spineandwellness.chiromatrixbase.com/online-forms.html

Office Hours

Day Open Closed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00 9:00 7:00 9:00 9:00 8:00 **8:30
8:30 7:30 7:30 8:00 7:00 2:00 4:00

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