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Online Forms

Steele Chiropractic, Inc. offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Please bring in any required printed forms with you on your appointment date. 

Patient Online Intake Form - Required for all patients

*(Standard Pediatric Evaluation portion of the form only required for patients under 16 years of age)*

*Once complete, please use mouse for signature & be sure to click on the "SUBMIT" button in order to complete the process*

Fill Out & Submit


Assigned Insurance Consent - Required if Filing Insurance

Download & Print Form


HIPAA Privacy Practices - Read Online and/or Print Copy for your records

Download & Print Form


Acknowledgement of Privacy Practices - Required for All Patients

Download & Print Form



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Locations

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Office Hours

Our Regular Schedule

Monday:

8:00am - 12:00pm

2:00pm - 6:00pm

Tuesday:

8:00 am- 12:00pm

2:00pm - 6:00pm

Wednesday:

8:00am - 12:00pm

2:00pm - 6:00pm

Thursday:

8:00am - 12:00pm

2:00pm - 5:00pm

Friday:

8:00am - 1:00pm

Closed

Saturday:

Closed

Closed

Sunday:

Closed

Closed