New Patient Paperwork

Fountain Chiropractic Clinic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.

Introductory Card

HIPAA Form

Authorization & Assignment

Consent to Treat a Minor - 18 and Younger

OFFICE HOURS


Monday
9:00am - 6:30pm


Tuesday
12:00pm - 6:00pm


Wednesday
9:00am - 6:30pm


Thursday
12:00pm - 6:00pm


Friday
9:00am - 6:00pm


Saturday
By Appointment Only

Fountain Chiropractic Clinic
24640 Telegraph Road
Flat Rock, MI 48134
(734) 782-0200