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Online Forms

Brodheadsville 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. Our fax number is 570-992-8759.

We look forward to meeting You!

 Here are some ways to make sure that your first visit with us is a great one:

- Allow enough time.  Reserve about 60-90 minutes for your first visit.  This gives us enough time to conduct a through examination and evaluate our findings.  Future visits will be considerably shorter.

- Bring Information. Please print and fill out the forms on this page and bring them with you. Also bring along documentation of prescriptions, surgeries, accidents, or other details that could have a bearing on your current health situation.  If you had spinal x-rays or MRIs taken at another location, please bring them with you.

- Supply authorizations.  If your case requires employer approval or was the result of a traffic accident, bring the needed authorizations and policy numbers.  (Please notify our office immediately if this is the situation.)

Perhaps more importantly, come with an optimistic attitude and a desire for better health.  We'll explain everything in advance and offer choices along the way.

All of us at Brodheadsville Chiropractic look forward to helping you regain your health and attain your health goals.  Please feel free to call is you have any questions.

Patient Information Forms - Required

Download & Print Form

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 the Free AdobeReader®

Sign Up Using the Form Below or Call 570-992-7626 to Make an Appointment.

Office Hours

Our Regular Schedule

Brodheadsville Chiropractic


8:30 am-12:00 pm

3:00 pm-7:00 pm


8:30 am-12:00 pm


8:30 am-12:00 pm

3:00 pm-7:00 pm




8:30 am-12:00 pm

3:00 pm-7:00 pm


9:00 am-11:00 am




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