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Request an Appointment


Schieber Chiropractic & Acupuncture offers our patient forms online so you can complete them in the convenience of your own home or office.

  • If you do not already have Adobe Reader® 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.

New Patient Health History Form - Required

The New Patient Health History Form provides us with information regarding the history and current state of your health.  What questions, concerns and goals regarding wellness can we help you with?  Let us know!

Download & Print Adult Patient Form

Download & Print Pediatric Patient Form

Download & Print Workers Comp Form

Download & Print Auto Accident Intake Form

Member Wellness Registration Form - Optional

The Member Wellness Registration 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 office. You can print it out and bring it in to our office 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 office and website more interactive and rewarding!

Download & Print Form

Download the Free Adobe Reader®
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