5800 Monroe St. A11 Sylvania, OH

Online Forms

Harmony Chiropractor Center, Inc 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

This lets us know the history and current state of your health. This form will be used as part of your history and exam. Let us know if there are any questions, concerns, goals, regarding wellness that we can we help you with.

If your main problem is a musculoskeletal or pain complaint, click the button below to download our New Patient Forms.

 

If you (or the patient) have a neurological complaint like Vertigo, ADHD, Dyslexia or Post-Concussion Syndrome, then please download and print the following form.

New Patient Form – Neuro

Female Health History Questionnaire

Please let the Doctor know if you have any concerns and we will provide you with the Female Health History Questionnaire.

Notice of Privacy Policy Form

This is included in the new patient forms, but if you want to print a copy for your records you may do so below.

Download & Print Form

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