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Patient Forms for San Jose

New Patient Form

If you are coming to our clinic for the first time, please complete the form below to save time at your first visit. We look forward to serving you!

As a patient of the Palmer Chiropractic Clinic, you have certain privacy expectations as well as rights and responsibilities. Our clinic is fully compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security rules for health care providers. The confidentiality of your patient records is of paramount concern to us, and you’ll be asked to review information about how we comply with HIPAA rules and sign a form on your first visit.

Your Privacy, Rights and Responsibilities

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Request an Appointment!

Complete this short form to get an appointment at our clinics.

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Patient Stories

Hear what our patients say about their experience.

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