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205-967-6776

Back On Track 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 Forms

Please include your email on your form.  If you are going to receive acupuncture, there will be an additional authorization form for you to sign in the office.

Patient History

Authorization Form

Acupuncture Authorization 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



Download the Free AdobeReader®

Exclusive Offer

Exclusive Offer

New Chiropractic Patient Special $75 (includes, consultation, examination and adjustment)

 

New patients receive First Acupuncture Treatment $35 (normally $55.)

Office Hours

Starting in August the FIRST and LAST Sundays of Each Month, Hours will be 5:00pm - 7:00pm
Day
Monday7am-12pm
Tuesday2pm-6pm
Wednesday7am-12pm
Thursday2pm-6pm
Friday7am-12pm
Saturday
Sunday10am-12pm

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