Dr. Gary Auerbach

Chiropractic Physician

Ladies and Gentlemen, the following are new patient forms for the office of Auerbach Chiropractic Arts and Science.

The forms are unable to be saved, so please leave the page open until complete and then print a copy to bring into the office as well as a second copy if you wish to have one for your records.

New Intake Patient Form
[estimated 20 mins to complete]
Interactive Manual Fill-in and Print


Simple Download and Print

Activities of Daily Living Survey
[estimated 5 mins to complete]
Interactive Manual Fill-in and Print