Online Forms

Pediatric Patient Intake FormCumming Chiropractic Center offers our patient form(s) online so they can be completed it 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!

Fill Online Form


Child under 14 New Patient Health History Form 

Fill Online Form


Pediatric Patient Intake Form

Fill Online Form



Patient Update Form 

Fill Online Form


Personal Injury Health History- Required for Personal Injury

Fill Online Form

Pediatric Patient Intake Form


New Patient Auto Intake

Fill Online Form


New Patient CASH Form

Fill Online Form


New Patient Child, PPW

Fill Online Form



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Office Hours

Our Regular Schedule

Monday:

8:30 am-12:30 pm

3:00 pm-5:00 pm

Tuesday:

2:30 pm-6:30 pm

Wednesday:

8:30 am-12:30 pm

3:00 pm-6:00 pm

Thursday:

Closed

Closed

Friday:

8:30 am-12:30 pm

3:00 pm-5:00 pm

Saturday:

Closed

Closed

Sunday:

Closed

Closed

Location

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Testimonials

Reviews By Our Satisfied Patients

  • "I love coming here! The staff is friendly and welcoming. Dr. Jason has helped to take away a lot of my back pain. The best part is that it's helped with my headaches. I rarely have any after having a minimum of 5 a week. Just awesome!"
    Rhonda J.

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