New Patient Paperwork
Fountain Chiropractic Clinic offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® installed on your computer,
Click Here to download. - Download the necessary form(s), print them out and fill in the required information.
- Bring the necessary form(s) to your appointment.
Introductory Card
HIPAA Form
Authorization & Assignment
Consent to Treat a Minor - 18 and Younger
OFFICE HOURS
Monday
9:00am - 6:30pm
Tuesday
9:00am - 6:00pm
Wednesday
9:00am - 6:30pm
Thursday
9:00am - 6:00pm
Friday
9:00am - 6:00pm
Saturday
9:00am - 12:00pm
Fountain Chiropractic Clinic
24640 Telegraph Road
Brownstown Charter Twp, MI 48134
(734) 782-0200