Online Forms

Agape Chiropractic offers our new patient forms online so you can complete them 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 forms, print them out and fill in the required information.

New Patient Packages

The forms should be printed and filled in completely prior to coming in for your first visit.  Do not attempt to fill in the forms electronically.  Use the link that best applies to your status.  To view our Privacy Practices, click here.

1.  Patients involved in litigation pertaining to an injury for which they are seeking care, please complete this package (this is for patients that are seeking care in which the at-fault party will be responsible for health care bills):
Litigation Patient Package

2.  Patients injured in an Automobile Accident, please complete this package (this is usually for patients that were at fault in an automobile accident that will be responsible for their co-payment and deductible)::
Non-Litigation Automobile Accident Package

3.  Patients using their Health Insurance, please complete this package (this is usually the regular health care insurance or PPO policy holder):
Health Insurance Package

4.  All other patients, please complete this package (this is the easiest package and is usually for the self paying patients):
Most Patients

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!