Online Forms For Chiropractic Health Clinic

Chiropractic Health Clinic 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 Intake Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Fill Out Now


Consent to Treat Minor Form

If we are treating a minor, we will need you to fill out this form and bring with you to your first appointment.

Download & Print Form


Auto Accident Form

If you are going to be treated for injuries suffered in an auto accident, please fill out this form and bring to your first appointment.

Download & Print Form


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New Patients Receive a Free Consultation*

Sign-up using the form or call us at (402) 778-5470 to take advantage of this exclusive offer.

Location


Office Hours

Monday:

7:00 am-6:00 pm

Tuesday:

8:00 am-6:00 pm

Wednesday:

7:00 am-6:00 pm

Thursday:

8:00 am-6:00 pm

Friday:

7:00 am-5:00 pm

Saturday:

8:00 am-11:00 am

Sunday:

Closed

Testimonials

  • "My health has improved considerably thanks to Eiler"
    Jane Doe / Omaha, NE
  • "I have benefited tremendously from the chiropractic care I received from Eiler."
    John Doe, Omaha, NE