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 Adobe Reader® 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.

 

Additional Forms

Low Back Pain

Please print out the above forms and fill it out if you have low back pain.

Neck Pain

Please print out the above form and fill it out if you have neck pain.

Headaches

Please print out the above form and fill it out if you have headaches.

Upper Extremity

Please print out the above form and fill it out if you have shoulder, arm, elbow, forearm, wrist or hand pain.

Lower Extremity

Please print out the above form and fill it out if you have pain in your thigh, knee, lower leg, ankle or foot.

Motor Vehicle Collision

If your condition is related to a car collision claim,  please fill out this form. Please ask if you have any questions.

Worker's Compensation Claim

If your condition is related to a workplace injury claim,  please fill out this form. Please ask if you have any questions.

Shoulder Pain

Please print out the above form and fill it out if you have shoulder pain.

Knee Pain

Please print out the above form and fill it out if you have knee pain.

Neurology – 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

Do not print 

 

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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