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Human Potential 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!

Download & Print Form


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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THIS ---->https://hpchiro1.com/online-forms.html

Office Hours

DayMorningAfternoon
Monday9:00am7:00pm
Tuesday9:00am7:00pm
Wednesday3:00pm7:00pm
Thursday3:00pm7:00pm
Friday9:00am7:00pm
Saturday9:00am2:00pm
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00am 9:00am 3:00pm 3:00pm 9:00am 9:00am Closed
7:00pm 7:00pm 7:00pm 7:00pm 7:00pm 2:00pm Closed

Testimonials

The great thing about Dr. Imana, is that he truly cares about his patients. He listens and offers as much help as he can even if its about other subjects. The office has a nice, clean, and calming atmosphere. It is definitely worth going to see this doctor. It improved my life greatly!

Alana G.
New York, NY

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