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Request an Appointment

860-620-9523

Grant Chiropractic Health Center, LLC offers our patient form(s) online so you can complete 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) to 860-620-9628 or bring it with you to your appointment.

New Patient Health History Form

This let's 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

If you have been in an auto accident, please go to this link, print out this form, fill it out and bring it in or fax to 860-620-9628.  Thank you!

http://www.eznotesinc.com/docs/Auto%20Accident%20Questionnaire.pdf

If you have been in a work related accident, please click on this link, print and fill out form and bring it in or fax to 860-620-9628.  Thanks!

http://www.eznotesinc.com/docs/Work%20Comp%20Intake%20Form.pdf


New Patient Health History Form

Download & Print Form



Download the Free AdobeReader®

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