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Online Forms

Weimer Chiropractic Professional Corporation offers our patient form(s) 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.

Here is what to do...

  • Download the required form(s) below, print it out and fill in the required information.
  • Please print legibly on all forms. If you require more room to answer any of the questions, please write on a separate sheet of paper.
  • Please answer all questions completely and truthfully, everything is received in strict confidence.
  • If you have any questions about the forms please call our office.
  • Fax us your printed and completed form(s) or bring it with you to your appointment. Our fax number in 209-300-7987

New Patient Health History Form - Required

The New Patient Health History Form contains four parts

  1. "Tell us about Yourself" - Share some basic information about yourself to help us get to know you.
  2. "Medical History" - To rule out disease, as well as determine if you are healthy enough to receive chiropractic care.
  3. "Chief Complaint" - Give us information about how we may help you.
  4. "Additional Complaints" - If needed, give us information about anything else we can help you with.

Generally, the forms take 20-40 minutes to complete, depending on the complexity of your case and the amount of medical history present.

The current documents can be provided at our 2813 Coffee Rd. Office during your first visit. Printing the appropriate form from to two options below can reduce you time in the office and give you the opportunity to check your answers to make certain important information is not left out.

Download & Print forms for Insurance or Self Pay from our PDF Documents.

Download & Print Forms for Personal Injury (Lein) and/or Auto Accident PDF Documents.

Please visit more of our New Patient Center to get more information about what you will experience during your visit.


Testimonials

  • "Weimer Chiropractic is committed to helping me as long as it takes to find the best solution. I never have to worry they will back out or give up if a solution is not reached immediately, which has been a problem for me in other places. They also allow me to text the office for a same day appointment on days when I wake up in pain from sleeping in a bad position. They always dress so professionally here, the entire staff makes an effort to maintain a professional appearance. When comparing them with other Chiropractors I have visited for the same conditions of neck, back, leg and foot pain, Dr. Weimer is the best."
    Don, shortened from the original posted on Wellness.com
  • "Dr. Weimer is amazing, saved me from having to get surgery."
    Ashley C. Wrote this on Facebook, in August 2017
  • "Two car accidents 20 years ago left me with chronic low back and neck pain. Other chiropractors had no results. Dr. Weimer must have gone to some great schools because he knows more that any Chiropractor I have talked too. Thanks to Dr. Weimer I am PAIN FREE."
    Don J.
  • "All I have to say is Dr. Weimer is a miracle worker."
    Lori. D. Wrote this on Yelp

Location

One Location to Serve You!

Office Hours

Primary Location

Monday:

9:00 am - 12:00 noon

2:00 pm - 6:00 pm

Tuesday:

9:00 am - 12:00 noon

2:00 pm - 6:00 pm

Wednesday:

9:00 am - 12:00 noon

2:00 pm - 6:00 pm

Thursday:

Closed

Closed

Friday:

9:00 am - 12:00 noon

2:00 pm - 6:00 pm

Saturday:

Closed

Closed

Sunday:

Closed

Closed