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215 Spencerport Rd Rochester, NY 14606
(585) 429-5680

Gerlach Chiropractic 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 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 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! This form will save you time at the doctors office. Please fill out one of the options below.

Online New Patient Form

Download & Print Form - Fax or bring this form with you to your appointment.

Lifestyle Wellness Member Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. This gives you access to our new letter and instructional videos to help you meet your Lifestyle Wellness Goals. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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!

Download & Print Form

Download the Free AdobeReader®

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