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EXPERIENCE - INTEGRITY - RESULTS

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Online Forms

Phillips Family Chiropractic offers our patient forms 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.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed forms at 724-287-0496 or simply bring them with you to your appointment.

If you are a new patient to our office or if it has been more than 3 years since your last office visit, please fill out Parts 1 and 2 of the New Patient Intake Form.

New Patient Intake Form (Part 1 of 2)

Download & Print Form

New Patient Intake Form (Part 2 of 2)

Download & Print Form

Massage Therapy New Patient Intake Form

Download & Print Form


Authorization to Release Records

Download & Print Form

UPMC Authorization to Release Records

Download & Print Form


Workmans Comp

Download & Print Form

Auto Accident Form

Download & Print Form



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