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6703 Shannon Parkway, Suite 13

Union City, GA 30291 US

(770) 964-3334

Online Forms

Here is the link to get to the paperwork for Family Chiropractic. Please remember these few things as you are filling out this information:

  • Give yourself some time to fill in this information. It may take you as long as 45 minutes to complete it.
  • Fill it in as accurately as you can, as this information will be directly loaded into our patient system, saving you as much as 1 hour in our office. :-)
  • SIGN THE FORM FIRST. Go all the way to the bottom of the form, when you get to the signature portion, USE YOUR MOUSE to sign by holding down the left mouse button and signing your name. Then go back up to fill in the form. We don't want you to lose your entered information by trying to figure out how to sign the form.
  • DO NOT exit off the page. YOU WILL LOSE YOUR INFORMATION. Stay on the page until you are through and the information has been submitted.
  • Please enter as many symptoms as you are experiencing, you may enter as many as four (4). In order to add additional areas of discomfort as additional complaints, select Yes in response to "Do you have an additional complaint?" right before the section "Review of Symptoms."
  • Once the information has been submitted, you will receive a message stating it was sent.

Please call our office at (770) 964-3334 for any questions.

Please read the above paragraph before filling out the online form.

ChiroTouch Patient Intake Form

To reduce the time spent in the office during your visit, please print out these forms and fill them in thoroughly. Remember to bring them in on your first visit. If you have any questions while filling them out, please give Family Chiropractic a call at (770) 964-3334.

See you in the Clinic!

Please temporarily allow pop-ups for the forms to show when you click on them. 

General Intake Forms  - If you have never been to our office or if it has been 3 or more years since you received care in our office, please fill out this form.

Accident History Questionnaire - If you were in an automobile accident, please fill out this form.  (You do NOT need to fill out the General Intake Form as well.) Please understand, you will be asked the specifics of your accident in the office. 

Patient Update - If you have been a patient in our office within the past three years, but haven't received care in six months or more, please fill out this form.  If you aren't sure when your last appointment was, please call our office at (770) 964-3334 and we will be happy to let you know.

Re-exam Questionnaire - It happens to all of us.  We have our paperwork in our hands and we forget to bring it home from the office.  Don't fret!  Go ahead and print this out, and fill out pages 2 through 5. We'll help you fill out page 1 before your re-exam.

We are looking forward to seeing you at Family Chiropractic!

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Proudly serving: Union City, Fairburn, Palmetto, College Park, Newnan, East Point, Riverdale, Tyrone, Peachtree City

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