Chiropractic Patient Form
DOWNLOAD.PRINT.SCAN.SUBMIT
Please DOWNLOAD the Patient Form, then PRINT, and fill out the necessary fields
DOWNLOAD ENGLISH VERSION
DOWNLOAD SPANISH VERSION
Your Information is Fully Protected
Click the button to DOWNLOAD or directly PRINT. Fill out all necessary fields. When you’re finished, just SCAN the papers and UPLOAD them to the “Submit the Form”↓option↓.
Check out our other Services:
Pain Relieving Services
Solution to Back Pain, Neck Pain & Headache. Safe, effective and provides long term relief.
Sports/Athletic Pain
Dr. Williams is board certified as a Certified Chiropractic Sports Physician or CCSP.
Auto Injury Recovery
Combination of chiropractic care, rehabilitative exercise, and soft tissue care.
DOWNLOAD SPANISH VERSION
Now click on BROWSE FILES and Upload/Attach the Scanned papers. Submit it with your Name, Email and Phone. THANKS!
Dr. Alex Williams
DC, MS, CCSP
info@acutechiro.net
Call
(253) – 426 – 1000