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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.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print out, and fill in the required information.
  • You may bring the form(s) with you to your appointment, or fax them to (585) 442-1017.

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.

Download & Print Form


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.

Download & Print Form


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.

Download & Print Form


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.

Download & Print Form


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!

Download & Print Form


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