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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.

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form

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