Dear new patient,
Please have an appointment scheduled before filling out forms. Your forms do not show up until you are on our appointment schedule.
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 (most pain in) the primary problem area (you can only highlight areas that touch each other) if you have another area of complaint, 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.
Thank you for choosing Bloomfield Chiropractic Center for your health and wellness needs
Click here for our New Patient Forms and it will take you to our secure site