All of us have had health-related issues at some time or other. Whether it's low back pain, headaches, asthma, gastritis, an ankle sprain, or a rotator cuff injury, we've all had a health problem ...View Article
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At Greater Rochester Chiropractic we offer you the opportunity to download the necessary form(s) to fill out before your first visit. If you decide not to fill these out before you arrive, please arrive 15 minutes early.
X-ray and lab reports
Although we can request previous reports after you get here, you are encouraged to bring any related reports with you.
Medications and supplements
If you decide not to fill out forms prior to your first visit, please bring a list of medications and supplements with you.
Form #1: Confidential Patient Information
This lets us know the history and current state of your condition and health. Everyone must fill out this form unless they are under the age of 10. If under the age of 10, kindly fill out the Pediatric form below.
Form #2: Functional Rating Index
Everyone must fill out this form unless they are under the age of 10. If under the age of 10, kindly fill out the Pediatric form below.
Form #3: Automobile Accident (No-Fault)
If the purpose of your visit is due to injuries sustained in a motor vehicle accident you must fill out this form in addition to Forms #1 and #2.
Pediatric Patient History
If the patient is under the age of 10, kindly fill out this form. You do not need to fill out any other forms.
Optional Form: Member Wellness Registration
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 chiropractic office. You can print the form out and bring it to your next appointment, 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 practice and website more interactive and rewarding!