Online Forms
Welcome!
If you are planning your first visit to Active Family Chiropractic & Acupuncture, we look forward to meeting you! To save time on your first visit, we encourage you to fill out our new patient forms below.
If you are printing out forms, and do not already have AdobeReader® installed on your computer, Click Here to download it now
Download the necessary form(s), print it out and fill in the required information.
Complete your forms and bring them in with you to your appointment or email them to the office you will be visiting
Columbus Forms
New Patient Intake Form
- CLICK HERE
Pediatric History Form
- CLICK HERE
Personal Injury Form
- CLICK HERE
Workers Comp Form
- CLICK HERE
English Reactivation Form
- CLICK HERE
Financial Policy and Consent to Treat Form
- CLICK HERE
Spanish New Patient Form
- HAGA CLIC AQUÍ
Spanish Personal Injury Form
- HAGA CLIC AQUÍ
Spanish Reactivation Form
- HAGA CLIC AQUÍ
Spanish Workers Comp Form
- HAGA CLIC AQUÍ
Kearney Forms
New Patient Intake Form
- CLICK HERE
Pediatric History Form
- CLICK HERE
Personal Injury Form
- CLICK HERE
Workers Comp Form
- CLICK HERE
Financial Policy and Consent to Treat Form
- CLICK HERE
English Reactivation Form
- CLICK HERE
Spanish New Patient Form
- HAGA CLIC AQUÍ
Spanish Personal Injury Form
- HAGA CLIC AQUÍ
Spanish Reactivation Form
- HAGA CLIC AQUÍ
Spanish Workers Comp Form
- HAGA CLIC AQUÍ
Hastings (South Burlington) Forms
New Patient Intake Form
- CLICK HERE
Pediatric History Form
- CLICK HERE
Personal Injury Form
- CLICK HERE
Workers Comp Form
- CLICK HERE
Financial Policy and Consent to Treat Form
- CLICK HERE
English Reactivation Form
- CLICK HERE
Spanish New Patient Form
- HAGA CLIC AQUÍ
Spanish Personal Injury Form
- HAGA CLIC AQUÍ
Spanish Reactivation Form
- HAGA CLIC AQUÍ
Spanish Workers Comp Form
- HAGA CLIC AQUÍ
Hastings (Cimarron Plaza) Forms
New Patient Intake Form
- CLICK HERE
Pediatric History Form
- CLICK HERE
Personal Injury Form
- CLICK HERE
Workers Comp Form
- CLICK HERE
Financial Policy and Consent to Treat Form
- CLICK HERE
English Reactivation Form
- CLICK HERE
Spanish New Patient Form
- HAGA CLIC AQUÍ
Spanish Personal Injury Form
- HAGA CLIC AQUÍ
Spanish Reactivation Form
- HAGA CLIC AQUÍ
Spanish Workers Comp Form
- HAGA CLIC AQUÍ
Grand Island (Webb Rd) Forms
New Patient Intake Form
- CLICK HERE
Pediatric History Form
- CLICK HERE
Personal Injury Form
- CLICK HERE
Workers Comp Form
- CLICK HERE
Financial Policy and Consent to Treat Form
- CLICK HERE
English Reactivation Form
- CLICK HERE
Spanish New Patient Form
- HAGA CLIC AQUÍ
Spanish Personal Injury Form
- HAGA CLIC AQUÍ
Spanish Reactivation Form
- HAGA CLIC AQUÍ
Spanish Workers Comp Form
- HAGA CLIC AQUÍ
Grand Island (Diers Ave) Forms
New Patient Intake Form
- CLICK HERE
Pediatric History Form
- CLICK HERE
Personal Injury Form
- CLICK HERE
Workers Comp Form
- CLICK HERE
Financial Policy and Consent to Treat Form
- CLICK HERE
English Reactivation Form
- CLICK HERE
Spanish New Patient Form
- HAGA CLIC AQUÍ
Spanish Personal Injury Form
- HAGA CLIC AQUÍ
Spanish Reactivation Form
- HAGA CLIC AQUÍ
Spanish Workers Comp Form
- HAGA CLIC AQUÍ
