New Patient Forms

Print, compete, and bring into the clinic for your first visit or scan and email forms to cac@srt.com

New Patient Forms if you are seeing Dr. Roedocker, Dr. Howe, or Dr. Falcon

Patient Registration

Please fill out personal information to the best of your ability.

Pediatric Health History
For children please fill out personal information to the best of your ability.
Patient Health History
Tell us about your past and recent injuries, surgeries, and medications.

New Patient Forms if you are seeing Dr. Jones

Pediatric New Patient

For children under 18 that will see Dr. Jones, fill out these to the best of your ability

 New Patient Intake

Adults seeing Dr. Jones, fill out these to the best of your ability

Forms to fill out no matter who you see

Financial Policy

Let us know who is responsible for your chiropractic visits.

Appointment Reminders
Chiropractic Arts Clinic may need to use your personal information to contact you.
Consent to be Treated

Understand that their are risks.

No Show/ Cancellation Policy

Understand that you are responsible for letting us know if you are not going to make an appointment.

HIPAA Privacy

We will not share any of your information without signed consent.