Bluffs Family 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 Forms - 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!

New Patient Intake Form

Pediatric New Patient Intake Form

Patient Health Information Consent Form (HIPAA) 


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. 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



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Contact

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Bluffs Family Chiropractic
303 McKenzie Ave
Council Bluffs, IA 51503
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  • Phone: 712-256-5990
  • Fax: 712-256-5998
  • Email Us

Business Hours

WE OFFER CONVENIENT HOURS!

We have both morning and afternoon hours and can often see you the same day!

Give us a call and we'll make sure that your time in our office is as convenient for you as possible!

Monday: 8 am - 11:30 am, 2 pm - 5:30 pm

Tuesday: 2 pm - 5:30 pm

Wednesday: 8 am - 11:30 am, 2 pm - 6 pm

Thursday: 8 am - 11:30 am, 2 pm - 5:30 pm

Friday: 8 am - 11:30 am