Online Forms

Potash Chiropractic 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.

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


Vehicle Accident Forms

Download & Print Form



Download the Free AdobeReader®

NEW PATIENT Special!

Click below for details!

Click Here

Office Hours

Monday:

9:00 am-12:00 pm

4:00 pm-7:00 pm

Tuesday:

4:00 pm-7:00 pm

Wednesday:

9:00 am-12:00 pm

4:00 pm-7:00 pm

Thursday:

Closed

Friday:

9:00 am-12:00 pm

4:00 pm-6:00 pm

Saturday:

10:00 am-12:00 pm

Sunday:

Closed

Location

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