Online Forms

Stern Chiropractic: A Creating Wellness Center 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: 914-752-1356 your printed and completed form(s) or bring it with you to your appointment.

Chiropractic New Patient Health Profile Form - Required

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

Creating Wellness Assessment Questionnaire

Your journey begins with your Creating Wellness Assessment. Using state-of-the-art, scientific technology and a comprehensive lifestyle questionnaire, our assessment evaluates your wellness in each of the 3 dimensions (Physical, Bio-Chemical, Psychological). The Creating Wellness Assessment measures and records such factors as nervous system function, body composition, stress response - and over 50 other factors that are crucial indicators of your over-all wellness. This evaluation allows us to focus on the specific needs that must be met in order for you to increase your wellness in all 3 dimensions.

 Download & Print Form

Creating Wellness Assessment Answer sheet

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!