Online Forms

All of the Forms You’ll Need, In One Place


Providing All Documentation In Advance for Seamless Appointments

PowerSource Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office before you even arrive at your first appointment.

  • 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 your printed and completed form(s) to (954) 567-1925, or bring them with you to your first appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns or goals regarding wellness can we help you with? Let us know! If you've been in a car or auto accident, we will need some additional information, but having this intake form filled out will save us time at your first visit. 

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 and news and events in our chiropractic office. You can print the form out and bring it into 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