(419) 843-15155215 Monroe Street #4 · Toledo, OH 43623
Fairwood Chiropractic & Physical Therapy

NEW PATIENTS

New patient paperwork

Fairwood provides PDF forms that can be completed at home or work. Download, print, and complete the necessary forms, then fax them or bring them to your appointment.

New Patient Paperwork

Download the clinic's new patient intake form.

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Children's New Patient Paperwork

Download the children's intake and consent form.

Download PDF →

HIPAA Privacy Information

Download the clinic privacy notice.

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The forms are provided as PDFs. You may need a PDF reader to open them.

These forms may request sensitive health information. Complete and return them directly to the clinic using its instructions; this static copy does not submit or transmit form data.