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904-619-2703
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Sign up using the form below or call us at 904-619-2703.

Jacksonville Chiropractic and Acupuncture offers our patient form(s) online so they can be completed it 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.

Attention: We are GREEN! 

We have a Paperless Electronic Health Record computer system. Please do not print and fill out the paperwork below unless the staff specifically asked you to.

New Acupuncture Patient

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!

Download & Print Form  We are going GREEN! We have a paperless office system. Do not print and fill out unless directed to by our staff. Thanks! 

New Patient Form- Auto Injury

Download & Print Form We are going GREEN! We have a paperless office system. Do not print and fill out unless directed to by our staff. Thanks! 


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Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.