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239-514-4004
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Exclusive Offer

HealthQuest Chiropractic & Laser Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you have email, call our office at 239-514-4004, and one of our friendly staff will email a link so you can fill out your in-take forms on-line.
  • 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) at 239-514-4044 or bring it with you to your appointment. To protect your privacy and to meet with Local and Federal Guidelines we request that you DO NOT email your completed forms. 

New Patient Demographic & 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


Privacy Policy - Required

Protecting your rights and privacy is a priority of our clinic.  Please sign this form to be maintained in your file for HIPAA requirements.  

Download & Print Form


Personal Injury Accident Form - Required for PI Patients

Please provide us information regarding how your accident happened and the conditions surrounding it. 

Download & Print Form


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 chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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!

Download & Print Form


Download the Free AdobeReader®

Featured Services

Services
We strive to provide complete care for our patients. Learn more about all the services we provide.
Make An Appointment
We will do our best to accommodate your busy schedule. Schedule an appointment today!
Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.