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Practice Name

Integrative Chiropractic Pediatrics / Palisades Family Chiroprac

Primary Location
16930 E. Palisades Blvd. Ste. 104
Fountain Hills, AZ 85268
Phone: 480-837-4444
Fax: 480-837-4874

Office Hours

Day
Monday9am-12pm2pm-6pm
TuesdayPhoenix LocationPhoenix Location
Wednesday9am-12pm2pm-6pm
ThursdayPhoenix LocationPhoenix Location
Friday9am-12pmClosed
SaturdayClosedClosed
SundayClosedClosed
Main Content

We offer our patient form(s) online so they can be completed in the convenience of your own home or 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.


Infant & Child New Patient Health History Form - Required

Please fill out to the best of your ability, sign and date.

Download & Print Form


Adult New Patient Health History Form - Required

Please fill out to the best of your ability, sign and date.

Download & Print Form


New Patient - Office Policy - Required for All

Please read, sign and date.

Download & Print Form


New Patient - Signature Form - Required for All

Please first read the HIPAA Information Form and Additional Information Disclosure Form below and then fill out, sign and date this form.

Download & Print Form

HIPAA Information Form (For reference only - do not need to print)

Additional Information Disclosure Form (For reference only - do not need to print)


Infant & Child Birth Record Release - Not Required at This Time

Please fill out, sign and date.

Download & Print 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, news, and events in our office.  You must sign up separately for each of these.  You can sign up for either one or both, however you can only sign up for the newsletter online.  You can print out the member wellness registration form and bring it in to our office or Click Here to register online!  We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



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3D Spine Simulator

 
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 3D Spine Simulator

Testimonial

Thank you for taking such good care of me over the past couple months. I feel so much better and my Mommy and Daddy tell me that I am such a joy to be around! Keep up the good work.

Love, Nicholas


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Make Appointment

We will do our best to accommodate your busy schedule. Request an appointment today!

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Services

We strive to provide complete care for our patients. Learn more about all the services we provide.

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Contact

Integrative Chiropractic Pediatrics / Palisades Family Chiroprac
16930 E. Palisades Blvd. Ste. 104
Fountain Hills, AZ 85268
Get Directions
 
  • Phone: 480-837-4444
  • Fax: 480-837-4874
  • Email Us
From:  To:  Get Directions
Driving Directions: Reverse Directions Print Directions

Office Hours

Day
Monday9am-12pm2pm-6pm
TuesdayPhoenix LocationPhoenix Location
Wednesday9am-12pm2pm-6pm
ThursdayPhoenix LocationPhoenix Location
Friday9am-12pmClosed
SaturdayClosedClosed
SundayClosedClosed
Newsletter

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Community Content
Member Wellness