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Online Forms

Miano Family Chiropractic Center, LLC 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.

New Patient Registration Form - Required

Please take your time and fill out this form as completely as possible.  This supplies our office with your personal and permissions to treat that are necessary to become a new patient.

Download & Complete

New Patient HIPAA Notification - Required

Please download and review this form. This is your notification of the HIPAA practices we utilize to protect your personal and medical information.

Download & Review

New Patient Health History Form - Required

Please be sure to fill out all pages of the form(s) completely.  This allows us to gather the information needed to properly analyze your condition and recommend appropriate care.

Chiropractic Intake Form (Adult): Download & Complete

Chiropractic Intake Form (Pregnancy): Download & Complete

Chiropractic Intake Form (Pediatric): Download & Complete

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Welcome New Patients!

Office Hours

Our Regular Schedule

Miano Family Chiropractic Center, LLC




3:00 pm-7:00 pm




10:00 am-1:00 pm


3:00 pm-7:00 pm






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  • "We value our patients' experience at the Miano Family Chiropractic Center, LLC. If you are currently a patient, please feel free to complete the following Chiropractic and/or Acupuncture Questionnaire. Please bring in your completed form to let us know what you think!"
    Jennifer L. Miano, DC, CACCP

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