Online Forms

Assurance Chiropractic Inc, WALK-IN CLINIC offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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 form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form



Download the Free Adobe Reader®

Use the form or call us at (928) 646-9220 to learn more about this exclusive offer.

Office Hours

Assurance Chiropractic Inc, WALK-IN CLINIC

Monday:

9:00 am-12:00 pm

2:00 pm-5:30 PM

Tuesday:

9:00 am-12:00 pm

2:00 PM-5:30 PM

Wednesday:

9:00 am-12:00 pm

2:00 PM-5:30 PM

Thursday:

9:00 am-12:00 pm

2:00 PM-5:30 PM

Friday:

9:00 am-12:00 pm

2:00 PM-5:30 PM

Saturday:

Closed

Sunday:

Closed

Location

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3D Spine Simulator

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