New Patient Forms

To help us prepare for your first visit to Dailey Chiropractic Care, please complete these new patient forms before you arrive. You may print and fill out the forms then fax (636.939.6704), or bring them to us on your first visit.

• Patient Application and Consultation
• HIPAA
• Informed Consent

In addition to the above forms, please bring with you an ID and insurance card, if applicable, for your first visit.  Children under 18 will need a parent or guardian for first visit to sign paper work and give consent for care.