New Patient Paperwork

Dickinson Chiropractic & Acupuncture offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.

  • New Adult Patient Registration Form (17 & older)

    Click to Download

  • New Pediatric Patient Registration Form (16 & younger)

    Click to Download

  • New Acupuncture Patient Registration Form

    Click to Download

OFFICE HOURS

Monday
7:45am - 5:00pm

Tuesday
8:30am - 6:00pm

Wednesday
9:00am - 3:00pm

Thursday
7:45am - 6:00pm

Friday
Closed

Saturday & Sunday
Closed

Dickinson Chiropractic & Acupuncture

3101 N Green River Rd Ste 850
Evansville, IN 47715

(812) 491-7777