St. Bernard Family Chiropractic offers our patient form(s) online so they can be completed it 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 form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Forms 

1. Minor Consent (Only required if patient/ wellness partner is under the age of 18).
2. Terms of Acceptance.
3. HIPPA form.
4. Financial Policy.
5. Patient & Emergency Contact Info.
6. Case History Form. **You may notice this form is probably different than other health care providers' forms. We ask about the birth process and other childhood injuries because they may be contributing to a lack of wellness causing you to become sick. Please answer all questions to the best of your ability, and Dr. St. Bernard will explain in detail when you arrive.

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!