Online Forms

Chiropractic Registration & History

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Civil Status
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Is patient covered by additional insurance?
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Is this condition getting progressively worse?
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Type of pain:
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Does it interfere with your
Activities or movements that are painful to perform
HEALTH HISTORY
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Indicate if you have any of the following:
Alcoholism
Allergys Shots
Anemia
Anorexia
Appendicitis
Arthritis
Asthma
Bleeding Disorders
Breast Lump
Bronchitis
Bulimia
Cancer
Cataracts
Chemical Dependency
Chicken Pox
Diabetes
Emphysema
Epilepsy
Fractures
Glaucoma
Goiter
Gonorrhea
Gout
Heart Disease
Hepatitis
Hernia
Herniated Disk
Herpes
High Blood Pressure
High Choles
Kidney Disease
Liver Disease
Measles
Migraines
Miscarriage
Mononucleosis
Multiple Sclerosis
Mumps
Osteoporosis
Pacemaker
Parkinson’s Disease
Pinched Nerve
Pneumonia
Polio
Prostate Problem
Prosthesis
Psychiatric Care
Rheumatoid Arthritis
Rheumatic Fever
Scarlet Fever
Sexually Transmitted Disease
Stroke
Suicide Attempt
Tonsillitis
Tuberculosis
Tumors, Growths
Typhoid Fever
Ulcers
Vaginal Infections
Whooping Cough
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EXERCISE
WORK ACTIVITY
HABITS
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Are you pregnant?
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Please do not submit any Protected Health Information (PHI).

Call

(212) 755-1717

book-now

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Immediate Appointments


133 E 58th St #1101, New York, NY 10022
(Between Lexington and Park ave)

Office Hours

Monday - Friday 

9:00am - 7:00pm


Insurance Accepted

Aetna 

Blue Cross Blue Shield 

Cigna 

Guardian 

Oxford 

PHCS

PHS 

UMR 

United Health Care 

...and many more!


Not Accepting

Medicaid 

Medicare 

HMOs or EPOs


Office Hours

Monday - Friday 

9am - 7pm


Patient Reviews

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A Medical Examination is Required to Diagnose and Treat Any & All Medical Conditions.



LOCATIONS

Find us on the map

OFFICE HOURS

Our Regular Schedule

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

9:00 AM-7:00 pm

9:00 AM-7:00 pm

9:00 AM-7:00 pm

9:00 AM-7:00 pm

9:00 AM-7:00 pm

Closed

Closed