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Practice Name

ChiroclinicHK

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Primary Location
445 West 50th Street
New York, NY 10019
Phone: 212-541-4294
Fax: 212-581-1114

Office Hours

DayMorningAfternoon
MondayClosedClosed
Tuesday10-2pm4-7pm
Wednesday10-2pm4-7pm
Thursday10-2pm4-7pm
Friday10-2pm4-7pm
Saturday11-2pmClosed
SundayClosedClosed
Main Content

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

Exclusive Offer

Featured Services

Services We strive to provide complete care for our patients. Learn more about all the services we provide. Make An Appointment We will do our best to accommodate your busy schedule. Schedule an appointment today! Online Forms Our patient forms are available online so they can be completed in the convenience of your own home or office.

Testimonial

Easy to get an appt and always available when I need them. Expert care at all times!!!

Melissa F.
New York, NY

Office Hours

DayMorningAfternoon
MondayClosedClosed
Tuesday10-2pm4-7pm
Wednesday10-2pm4-7pm
Thursday10-2pm4-7pm
Friday10-2pm4-7pm
Saturday11-2pmClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Closed 10-2pm 10-2pm 10-2pm 10-2pm 11-2pm Closed
Closed 4-7pm 4-7pm 4-7pm 4-7pm Closed Closed

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