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Online Forms

University Place Chiropractic offers our patient form(s) online so you can complete 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.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Downloadable Forms

For your convenience, below is a list of downloadable PDF forms that you can print up and fill out prior to your appointment:

Welcome Form

Personal Health History

Chiropractic Pediatric Health

Consent to Treatment Minor

Automobile Accident Questionnaire

Financial Policies

Notice of Privacy Practice


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