Online Forms

Palmetto Wellness Center offers our patient form(s) online so they can be completed it 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 form(s) or bring it with you to your appointment.

Chiropractic Case History/Patient Information 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!

Appointment Reminders and Health Care Information Authorization - Required

Your chiropractor and members of the practice staff may need to use your name, address, phone number, and your clinical records to contact you with appointment reminders, information about treatment alternatives, or other health related information that may be of interest to you. If this contact is made by phone and you are not a home, a message will be left on your answering machine. By signing this form, you are giving us authorization to contact you with these reminders and information.

Consent For Use Form - Required

We are very concerned with protecting your privacy.  While the law requires us to give you this disclosure, please understand that we have, and always will, respect the privary of your health information.

Download & Print

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!