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Online Forms

Dr. Diana Gailes 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!

Please complete our new patient health history form at the link below and bring it in at your next appointment!

New Patient Health History Form


Download the Free AdobeReader®

Contact Us

We look forward to hearing from you

Location

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Office Hours

203-983-5426

Monday:

9:00 am - 1:00 pm

3:00 pm - 6:00 pm

Tuesday:

5:00 pm - 8:00 pm

Wednesday:

9:00 am - 1:00 pm

3:00 pm - 5:00 pm

Thursday:

By Appointment

Friday:

9:00 am - 1:00 pm

3:00 pm - 6:00 pm

Saturday:

9:00 am - 1:00 pm

Sunday:

Closed