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Online Forms

Wells Family Chiropractic, PLLC offers our patient form(s) online so they can be completed it 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.  *Please note you only need one health questionnaire to fit patients age group or status.*
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Patient Privacy Policy - Please read and fill out section 5 and sign.

Download and Print Form


Photo Release Form - Please sign.

Download and Print Form


Informed Consent - Please read, fill out any required information and sign.

Download and Print Form


Waiver Form - Please read and sign in both sections.

Download and Print Form


Adult Chiropractic Health Questionnaire

This paperwork will provide us with your health history and information on your condition.  Print and fill out this form prior to your visit so that you can save time when you come into our office.  Anyone above the age of 15 will be asked to fill out this form, however if under the age of 18 a parent or guardian does need to sign with the child.

Download and Print Form


Child Chiropractic Health Questionnaire

This paperwork will provide us with the health history and information of your childs condition.  Print and fill out this form prior to your visit so that you can save time when you come into our office.  Please note that this form is for any child 15 and under.  It does need to be filled out and signed by a parent or guardian.

Download and Print Form


Infant Chiropractic Health Questionnaire

This paperwork will provide us with the health history and information of your infants conditions.  Print and fill out this form prior to your visit so that you can save time when you come into our office.  Please not that this form is for infants from 0-24 months old.  It does need to be filled out and signed by a parent or guardian.

Download and Print Form


Pregnancy Chiropractic Health Questionnaire

This paperwork will provide us with your health history and information on your condition.  Print and fill out this form prior to your visit so that you can save time when you come into our office.  Anyone pregnant will be asked to fill out this form, however if under the age of 18 a parent or guardian does need to sign with the child.

Download and Print Form


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Location

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Office Hours

Our Regular Schedule

Monday:

8:00 am - 10:00 am

11:30 am - 12:30 pm

3:00 pm - 5:30 pm

Tuesday:

Closed

Wednesday:

8:00 am - 10:00 am

11:30 am - 12:30 pm

3:00 pm - 5:30 pm

Thursday:

8:00 am - 10:00 am

11:30 am - 12:30 pm

3:00 pm - 5:30 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Testimonial

Reviews By Our Satisfied Patients

  • "Since starting care my back doesn't hurt anymore when I wake up in the morning and my hips feel more even. I still get colds but not nearly as often and they don't last as long. Everyone working in the office is kind and caring and always willing to help and answer questions."
    Jen / Tioga Center, NY