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Online Forms

My Chiro On The Go offers our patient form(s) online so they can complete them in the convenience of their own home or office.

  • Foms A-C can be completed online through the links below, all of them should take 10-15 minutes to complete. If you are being treated for an auto accident or personal injury please also complete forms D and E, these should also take 10-15 minutes to complete.
  • If you wish to print the paperwork instead please print forms F-K and complete prior to the Doctors arrival.
  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Fax us your printed and completed form(s) to (470)355-0136 or present them at your appointment.

Online Option:

Everyone Patient MUST fill out forms A-C Before receiving treatment 

A. New Patient Online Form -All

B. Complaint Form online (Fill out once for each area of complaint, If you do not have any complaints you may skip this form)

C. Informed Consent, HIPAA Release and Notice of Privacy

If you have been an AUTO ACCIDENT OR HAD A SLIP AND FALL please also fill out:

D. Car Accident Paperwork

E. After Accident Paperwork

Printable Option:

If you cannot fill out these forms online please print and complete the following prior to your appointment:

F. History Form- Printable

G. Patient Complaint form

H. Informed consent

I. HIPAA

J. Notice of Privacy

If you have been in an AUTO ACCIDENT OR HAD A SLIP AND FALL also print and fill out the following:

K. Vehicle Accident Information Form




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My Chiro On The Go

Monday - Sunday:

We can be available by request afterhours and on weekends (Fees will apply) Call (678) 842-4378 for availability.