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Steele Chiropractic, Inc. 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.
  • Please bring in any required printed forms with you on your appointment date. 

Patient Online Intake Form - Required for all patients

*(Standard Pediatric Evaluation portion of the form only required for patients under 16 years of age)*

*Once complete, please use mouse for signature & be sure to click on the "SUBMIT" button in order to complete the process*

Fill Out & Submit

Assigned Insurance Consent - Required if Filing Insurance

Download & Print Form

HIPAA Privacy Practices - Read Online and/or Print Copy for your records

Download & Print Form

Acknowledgement of Privacy Practices - Required for All Patients

Download & Print Form

Member Wellness Registration Form - Optional (Free!!)

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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