Patient Intake Forms
Download, print and fill out our paperwork in the comfort of your home.
Click the download button below to download our paperwork as a PDF Document and simply bring them with you to your next visit with Dr. Croucher.
[/pb_text][pb_buttonbar el_title="Button Bar" div_margin_bottom="20" buttonbar_alignment="inherit" buttonbar_show_title="yes" buttonbar_show_icon="yes" buttonbar_group="yes" appearing_animation="slide_from_left" appearing_animation_speed="medium" ][pb_buttonbar_item button_text=" Download Intake Form" link_type="url" button_type_url="images/Upstate_Chiro_intake.pdf" open_in="current_browser" icon="fa-cloud-download" button_size="default" button_color="btn-primary" ][/pb_buttonbar_item][pb_buttonbar_item button_text=" Get Adobe Reader" link_type="url" button_type_url="https://get.adobe.com/reader/" open_in="new_browser" icon="fa-file-pdf-o" button_size="default" button_color="btn-default" ][/pb_buttonbar_item][/pb_buttonbar][/pb_column][pb_column span="span4"][pb_promobox el_title="Adobe Reader Info Box" pb_title="Adobe Reader Required" pb_button_title="Required" link_type="no_link" div_margin_top="0" div_margin_bottom="0" pb_bg_value="#ffffff" pb_bg_color="#ffffff" pb_border_top="0" pb_border_right="0" pb_border_bottom="0" pb_border_left="0" pb_border_value="#A0CE4E" pb_border_color="#A0CE4E" pb_show_drop="no" elements="title__#__content__#__button__#__ " title_font="custom" title_font_face_type="google fonts" title_font_face_value="Open Sans" title_font_size="18" title_font_style="inherit" title_font_color="#000000" pb_button_size="btn-xs" pb_button_color="btn-danger" appearing_animation="slide_from_bottom" appearing_animation_speed="slow" ]In order to view and print our intake forms you must have Adode Reader. If you don't have Adobe Reader you can click the "Get Adobe Reader Button" to download and install it from the official adobe website.
It's free, safe, and takes less than 2 minutes.
[/pb_promobox][/pb_column][/pb_row][pb_row background="solid" solid_color_value="#5c5c5c" solid_color_color="#5c5c5c" border_width_value_="0" border_style="solid" border_color="#000" width_unit="%" div_padding_top="10" div_padding_right="10" div_padding_bottom="10" div_padding_left="10" ][pb_column span="span12"][pb_text el_title="Have A Question About Being " width_unit="%" enable_dropcap="no" appearing_animation="0" ]Have A Question About Being a New Patient? 315-635-2333
[/pb_text][/pb_column][/pb_row][pb_row background="pattern" pattern="images/patterns/debut_light.png" paralax="no" parallax_scroll="no" border_width_value_="0" border_style="solid" border_color="#000" width_unit="%" div_padding_top="20" div_padding_right="10" div_padding_bottom="20" div_padding_left="10" ][pb_column span="span3"][pb_list el_title="Intake Icon" show_icon="yes" icon_position="center" icon_size_value="32" icon_background_type="square" icon_background_color="#5c5c5c" icon_c_value="#ffffff" icon_c_color="#ffffff" show_heading="yes" font="inherit" appearing_animation="slide_from_top" appearing_animation_speed="slow" ][pb_list_item heading="Intake Forms" icon="fa-clipboard" ]Download and Print our intake forms.
[/pb_list_item][/pb_list][pb_button el_title="Intake forms" button_text="Learn More" link_type="url" button_type_url="patient-intake-forms" open_in="current_browser" button_alignment="center" button_size="default" button_color="btn-primary" appearing_animation="slide_from_bottom" appearing_animation_speed="slow" ][/pb_button][/pb_column][pb_column span="span3"][pb_list el_title="My first visit icon" show_icon="yes" icon_position="center" icon_size_value="32" icon_background_type="square" icon_background_color="#5c5c5c" icon_c_value="#ffffff" icon_c_color="#ffffff" show_heading="yes" font="inherit" appearing_animation="slide_from_top" appearing_animation_speed="slow" ][pb_list_item heading="My First Visit" icon="fa-street-view" ]What to expect at your first visit.
[/pb_list_item][/pb_list][pb_button el_title="My first visit button" button_text="Learn More" link_type="url" button_type_url="my-first-visit" open_in="current_browser" button_alignment="center" button_size="default" button_color="btn-primary" appearing_animation="slide_from_bottom" appearing_animation_speed="slow" ][/pb_button][/pb_column][pb_column span="span3"][pb_list el_title="Payment Icon" show_icon="yes" icon_position="center" icon_size_value="32" icon_background_type="square" icon_background_color="#5c5c5c" icon_c_value="#ffffff" icon_c_color="#ffffff" show_heading="yes" font="inherit" appearing_animation="slide_from_top" appearing_animation_speed="slow" ][pb_list_item heading="Payment Options" icon="fa-credit-card" ]Affordable care for everyone.
[/pb_list_item][/pb_list][pb_button el_title="Payment Options Icon" button_text="Learn More" link_type="url" button_type_url="payment-options" open_in="current_browser" button_alignment="center" button_size="default" button_color="btn-primary" appearing_animation="slide_from_bottom" appearing_animation_speed="slow" ][/pb_button][/pb_column][pb_column span="span3"][pb_list el_title="Gallery Icon" show_icon="yes" icon_position="center" icon_size_value="32" icon_background_type="square" icon_background_color="#5c5c5c" icon_c_value="#ffffff" icon_c_color="#ffffff" show_heading="yes" font="inherit" appearing_animation="slide_from_top" appearing_animation_speed="slow" ][pb_list_item heading="Gallery" icon="fa-picture-o" ]Photos of Upstate Chiropractic[/pb_list_item][/pb_list][pb_button el_title="Gallery Button" button_text="Learn More" link_type="url" button_type_url="gallery" open_in="current_browser" button_alignment="center" button_size="default" button_color="btn-primary" appearing_animation="slide_from_bottom" appearing_animation_speed="slow" ][/pb_button][/pb_column][/pb_row]
