Patient Forms

For your convenience, we offer our patient forms online. Please feel free to print the below forms and have them completed prior to your visit. Should you need any assistance, please feel free to contact our office!

Medical Intake Form
Authorization for Consent and Disclosure Form
Patient Privacy Disclosure
Terms of Acceptance


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Back to Basics Chiropractic Center 3620 Harlem Rd. Suite 1, Cheektowaga, NY 14215, Phone: (716) 446-0048

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