Online Forms

39 Chiropractic & Rehabilitation 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 Health History Form - Required

Adult - New Patient Form

Minor - New Patient Form


Download the Free AdobeReader®

Locations

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Office Hours

Berlin Office

Monday

8:00 am - 5:30 pm

Closed 12pm - 2pm

Tuesday

8:00 am - 5:30 pm

Closed 12pm - 2pm

Wednesday

8:00 am - 5:30 pm

Closed 12pm - 2pm

Thursday

8:00 am - 4:00 pm

Closed 12pm - 2pm

Friday

8:00 am - 5:30 pm

Closed 12pm - 2pm

Saturday

Closed

Sunday

Closed

Fredericksburg Office

Monday

8:00 am - 5:30 pm

Closed 12pm - 2pm

Tuesday

12:00 pm - 7:00 pm

Wednesday

8:00 am - 5:30 pm

Closed 12pm - 2pm

Thursday

Closed

Friday

8:00 am - 5:30 pm

Closed 12pm - 2pm

Saturday

8:00 am - 12:00 pm

Sunday

Closed

Berlin Office

Monday
8:00 am - 5:30 pm Closed 12pm - 2pm
Tuesday
8:00 am - 5:30 pm Closed 12pm - 2pm
Wednesday
8:00 am - 5:30 pm Closed 12pm - 2pm
Thursday
8:00 am - 4:00 pm Closed 12pm - 2pm
Friday
8:00 am - 5:30 pm Closed 12pm - 2pm
Saturday
Closed
Sunday
Closed

Fredericksburg Office

Monday
8:00 am - 5:30 pm Closed 12pm - 2pm
Tuesday
12:00 pm - 7:00 pm
Wednesday
8:00 am - 5:30 pm Closed 12pm - 2pm
Thursday
Closed
Friday
8:00 am - 5:30 pm Closed 12pm - 2pm
Saturday
8:00 am - 12:00 pm
Sunday
Closed