Accessibility View Close toolbar

Call Us Today

To schedule an appointment, call us at 607-766-9600

Online Forms

Detrick Family Chiropractic offers our patient form(s) online so they can be completed 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 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!

If you have Medicare or Medicare Advantage Health Insurance, please Download and Print this form

All other insurances Download & Print this form

Please also download and print the following two forms:

Medications

Receipt of Privacy Policy

If you would like a copy of our Privacy Policy you may download it here:

HIPAA Privacy Notice


Download the Free AdobeReader®