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Printable Forms

Wellcare Chiropractic would like to make the enrollment process as easy as possible for our new clients. Please use the forms listed on the left to print out the documents needed to start your care. Bring the completed forms to our office and it will facilitate our ability to help you!

  • 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.

Chiro Intake Paperwork - 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!

New Patient Intake Form

EHR Form

Bournemouth Neck Form

Bournemouth Back Form


Living Well Intake Paperwork

Download & Print Form


HIPPA Compliance Form

Download & Print Form


Patient Payment Policy

Download & Print Form


Download the Free AdobeReader®

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Office Hours

Our Regular Schedule

Hershey Office

Monday:

8:00 am-12:30 pm

2:00 pm-6:00 pm

Tuesday:

8:00 am-12:00 pm

Closed

Wednesday:

8:00 am-12:30 pm

2:00 pm-6:00 pm

Thursday:

8:00 am-12:00 pm

Closed

Friday:

8:00 am-12:30 pm

2:00 pm-4:00 pm

Saturday:

By Appt.

Closed

Sunday:

Closed

Testimonial

  • "Treatment at Well Care Chiropractic is a unique experience. When I had a chiropractic need and came here, I expected to be told I would be coming back twice a week for the next six months. However, Dr. Penny treated my symptoms and showed me practical strategies that addressed my whole person health. I was introduced to the LivingWell Program. As a result, my journey towards health has taken a positive turn."
    Tammy A - Hershey, PA