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Harlan Chiropractic & Acupuncture offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.

Introduction Patient Case Form - Required

Download & Print Form

Patient Case History Form - Required

Download & Print Form

Review of Systems Form - Required

Download & Print Form

Functional Rating Index Form - Required

Download & Print Form

HIPPA Form - Required

Download & Print Form



Download the Free AdobeReader®

Exclusive Offer

New patients receive a free consultation where Dr. Harlan will discuss the benefits of care and determine if you are a candidate for Chiropractic & Acupuncture.

THIS ---->https://drchrisharlancom.chiromatrixbase.com/online-forms.html

Office Hours

DayMorningAfternoon
Monday9 - 13 - 6
Tuesday9 - 13 - 6
Wednesday9 - 13 - 6
Thursday9 - 13 - 6
Friday9 - 11Closed
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9 - 1 9 - 1 9 - 1 9 - 1 9 - 11 Closed Closed
3 - 6 3 - 6 3 - 6 3 - 6 Closed Closed Closed

Testimonial

I was told I needed to see a surgeon for my shoulder rotator cuff tear. After seeing Dr. Harlan, I can lift my arm up above my head again without pain. Thank you.

Sharon W.
Overland Park, KS

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