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Online Forms

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

Download the Free AdobeReader®