Dear Patient,

We are so glad that you have trusted your chiropractic care to us.  We are looking forward to meeting you at your first appointment.  Below are our new patient forms.  We understand that it is a considerable amount of paperwork, but by printing and completing the forms at home you will shorten the time necessary for your first appointment.

Please take the time to fill all the forms out completely.  The information is needed by the doctor to ensure a complete examination.

Thank you,

Dr. Mirabella and staff
New Patient Chiropractic Case History and Patient Information Form
New Patient Forms
Consent To Treat A Minor
necessary for all patients under the age of 18.
Auto Accident Form
Work Related Accident Form
Other Forms
Not all forms are available at this time.  Auto Accident Form, Work Related Accident Form and Patient Update form will be available in the near future.

Sorry For The Inconvenience
Welcome To
Teller County Chiropractic
The following two forms are required for all patients.
Missed Appointment Policy
If applicable please complete these additional forms as well.