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New Patient Forms

Back In Shape Chiropractic offers our patient form(s) online so they can be completed prior to your first appointment in the convenience of your own home or office.

  1. If you do not already have AdobeReader® installed on your computer, Click Here to download.
  2. Download the necessary form(s) by clicking below, print them and fill in the required information.
  3. Bring the completed forms with you to your appointment.

Patient Paperwork and Notices

Please Call/Text Us and we can email a link to fill out forms online that will link to your file.  

Non-Discrimination Policy

It is the policy of Back In Shape Chiropractic to not discriminate with respect to its services and employment practices. Back In Shape Chiropractic will not unlawfully discriminate, exclude, or deny services, or benefits to any person on the basis of a status protected by law from discrimination including: race, color, religion, national origin, gender or gender identity, creed, national origin, age, disability, veterans status, sexual orientation, marital status (including domestic partnerships), or any other legally protected status or class.   


Notice of Our Privacy Policy




Download the Free AdobeReader® (This program is needed to view and print the forms)

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Would You Like A Free Phone Consultation With Dr. Segal? No Problem.

Our Location

Office Hours

Monday:

8:30 am-6:00 pm

Tuesday:

9:00 am-4:00 pm

Wednesday:

8:30 am-6:00 pm

Thursday:

9:00 am-5:30 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed