Safe Harbor Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive at our office.
- If you do not already have AdobeReader® installed on your computer, click here to download the latest version.
- Download the necessary form(s), print and complete.
- Simply bring your completed forms with you to your first appointment. Alternately, you can scan and email them to us at [email protected] or fax your completed forms to (716) 648.7631
New Patient Health History Form - Required
The information gathered within these forms lets us know your health history as well as your current health status. Patient intake is accessed online and will be sent securely to our software upon completion. Please print and complete all other forms and bring them along to your initial evaluation. What wellness-related questions, concerns, and goals can we help you with? Let us know! Please note that patients aged 15 and under must have our Pediatric Case History & Intake completed on their behalf. Click the link above to complete our online intake forms. Please note this form is not mobile-friendly.
Patient Intake Online Form Click this to complete our online intake forms. Please note this form is not mobile-friendly.
Please note that patients aged 15 and under must have our Pediatric Case History & Intake completed on their behalf.
Patient Authorization Download & Print Form
Privacy Policy Download & Print Form
Terms of Acceptance & Office Policy Download & Print Form
Pediatric Case History & Intake (for patients aged 15 and under) Download & Print Form
Progress Exam Forms
Progress Update Download & Print Form
Nutritional Therapy Forms
If you are scheduled for either a Nutrition Response Technique appointment or Heart Sound Recorder appointment, please download and complete these forms prior to it. Kindly note that the Nutrition Response Therapy Complete Packet requires several days of food logging, so the earlier you can look at these before you appointment, the better. Disregard and do not completeBarnes' Thyroid Test on page 3.
For an initial Heart Sound Recorder appointment, please review Heart Sound Recorder Initial Preparation Instructions and follow them as closely as possible.