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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