Patient Forms

Dear new patient,

Thank you for choosing Bloomfield Chiropractic Center for your health and wellness needs. Please have an appointment scheduled before filling out forms.

 Please follow the link below to our Secure new patient portal. You will be asked for your personal  information, history and complaints. 

When you are filling out your health complaints click on the body diagram in the areas that you feel pain, start with the area that you are having the primary problem in (you can only highlight areas that touch each other) at the end of the page you can click on "I have other complaints" and do the same for each area that you are having pain in. 

Please bring a copy of your insurance card, Id and a list of any medication you might be taking.

Click here and it will take you to our secure site

Office Hours

Our General Schedule

Monday:

9:00 am-12:30 pm

2:30 pm-6:00 pm

Tuesday:

9:00 am-12:30 pm

2:30 pm-6:00 pm

Wednesday:

9:00 am-12:30 pm

3:30 pm-6:00 pm

Thursday:

Closed

Friday:

9:00 am-12:30 pm

2:30 pm-6:00 pm

Saturday:

By Appointment Only

Sunday:

Closed

Our Location

5755 West Maple Road, Suite 107 | West Bloomfield, MI 48322