Forms

Here is the iConnect Family Chiropractic intake paperwork. If you plan on coming in to our Westwood office please feel free to bring in the completed forms to expedite your wait.

 

 

New Patient Intake form (required)
General Patient Intake Form.pdf
Adobe Acrobat document [523.2 KB]

For females over the age of 16 please fill out the additional form:

Female intake paperwork
For Women over age of 16 Form.pdf
Adobe Acrobat document [47.0 KB]

For pediatric patients we have two forms, one for the general pediatric populaton and another for children with concerns:

Standard Pediatric Intake Form
Standard Pediatric Evaluation.pdf
Adobe Acrobat document [328.4 KB]
Intensive Pediatric Intake Form
Intensive Pediatric Evaluation.pdf
Adobe Acrobat document [337.4 KB]

Need an Appointment?

Give us a call at:

(201) 399-3797

 

email: info@iConnectchiro.com

 

Dr. Rich Minuski/Westwood and West New York Chiropractor


Address:

227 Washington Ave

Westwood, NJ 07675

323 60th St

West New York, NJ 07093

 

Check out our affiliates website at http://www.intrinsicnj.com/

Contact Details

Office Hours:

Monday: By appointment

Tuesday: By appointment

Wednesday: By appointment

Thursday: By appointment

Friday: By appointment

Saturday: By appointment

*Our priority is to work with your schedule to provide optimal care.