University 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) relevant to you, 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.

Download Our New Patient Forms Here

New Patient Forms 1-3 

New Patient Forms 4-6

New Patient Health History Form - Auto Accident  

If you are seeking treatment due to an automobile accident, please complete the following form

Download & Print Form


 New Patient Health History Form - Work Injury 

If you are seeking treatment due to a work injury, please complete the following form

Download & Print Form


Children Health History Forms 

If you are seeking care for your child (under 18 years old), please complete the following form

Download & Print Form



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Contact

University Chiropractic
540 Bryant St.
Palo Alto, CA 94301
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  • Phone: 650-326-9812
  • Fax: 650-326-7442
  • Email Us
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