Patient Forms

Back to Health Chiropractic Office

Are you ready to become a patient at Back to Health Family Chiropractic in St. Albans? Ready to get your health and wellness on the right track without drugs, painkillers, or other harmful products? Great!

For your current, new, and prospective patients, we offer online, printable PDF versions of the paperwork you'll need to update before your appointment. The following links use Adobe Acrobat ReaderĀ® or similar PDF viewer installed on your device. Update your device with the latest version by click here to download it now.

Once you're done, you can either bring the forms with you to your appointment or send them to us by fax at (802) 527-2013.

New adult patient health history forms1 | New adult Medicare patient health history forms2 | New child patient health history forms3


1 Required paperwork for all patients 13 years of age and older.
2 Required for all patients with Medicare as their primary insurance provider.
3 Required for all patients 12 years of age and under. Please note, youth patients' parental guardian must be present during initial visit. For more information, contact us by clicking here.

No form settings found. Please configure it.

Please note...

While our office team is in 5 days a week to assist you, we only schedule appointments during doctor hours

Monday:

Office staff: 8am - 5pm

Doctors: Emergency only

Tuesday:

Office staff: 7:30am - 6pm

Doctors: 7:30am - 6pm

Wednesday:

Office staff: 8am - 6pm

Doctors: 3pm - 6pm

Thursday:

Office staff: 7:30am - 4pm

Doctors: 7:30am - 12pm

Friday:

Office staff: 8am - 1pm

Doctors: Emergency only

Saturday:

Office staff: closed

Doctors: Emergency only

Sunday:

Office staff: closed

Doctors: Emergency only