Online Forms

Online Forms

Nerves of Steele Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.

New Patient Registration, Informed Consent and Health History Form – Required

These forms let us know the history and current state of your health, give consent to Dr. Steele to treat you, and acknowledge receipt of Nerves of Steele Chiropractic Notice of Privacy Practices.  These are required in order for treatment to begin and bringing them with you, already filled out, enables you to spend more of your time in our office with Dr. Steele rather than filling out forms in the office.  If you are unable to download and print these forms, we do have a copy waiting for you in the office.

What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

Notice of Privacy Practices – Printing not required

This form can be read at home and DOES NOT require that you print it and bring it with you.  Nerves of Steele Chiropractic is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to your protected health information.  When you sign the New Patient intake forms which you bring with you, you acknowledge you have received THIS document.

View Form (May be Downloaded & Printed)