New Patient Paperwork
Synergy Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® installed on your computer,
Click Here to download. - Download the necessary form(s), print them out and fill in the required information.
- Bring the necessary form(s) to your appointment.
New Chiropractic Patient Paperwork
Click to Download
Pregnancy Intake Form
Click to Download
Neurofeedback Intake Form
Click to Download
Weight Loss Intake Form
Click to Download
Adult Self Report Scale Symptom Checklist
Click to Download
Child Self Report Scale Symptom Checklist
Click to Download
Terms of Acceptance
Click to Download
RemedyTesting - Intial Intake
Click to Download
RemedyTesting - Follow up
Click to Download
RemedyTesting - Pet Intake
Click to Download
RemedyTesting - Sample Report
Click to Download
Limits of Confidentiality/Cancellation Policy
Click to Download
Authorization to Disclose Information Form
Click to Download
OFFICE HOURS
Monday
9:00am - 6:00pm
Tuesday
9:00am - 6:00pm
Wednesday
9:00am - 6:00pm
Thursday
9:00am - 6:00pm
Friday
Closed
Saturday & Sunday
Closed
Synergy Chiropractic
6400 Farmington Rd Suite 114
West Bloomfield Township, MI 48322