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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)

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New Patient Intake Form (Part 2 of 2)

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Massage Therapy New Patient Intake Form

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Authorization to Release Records

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UPMC Authorization to Release Records

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Workmans Comp

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Auto Accident Form

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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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We strive to provide complete care for our patients. Learn more about all the services we provide.
Make An Appointment
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Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.