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Online Forms

Bina Chiropractic Wellness & Rejuvenation Center 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. Some forms need to be completed at the office when you come for the first visit

  • If you do not already have AdobeReader® installed on your computer, Click Hereto 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 Health History 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!

Download & Print Form



Download the Free AdobeReader®

Location

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Office Hours

No Walk Ins; all appointments by previous arrangement

Monday:

10:00 am-1:00 pm

3:00 pm-6:00 pm

Tuesday:

10:00 am-1:00 pm

Some Tuesdays

Wednesday:

10:00 am-1:00 pm

3:00 pm-6:00 pm

Thursday:

10:00 am-1:00 pm

3:00 pm-6:00 pm

Friday:

10:00 am-1:00 pm

Some Fridays

Saturday:

Closed

Sunday:

Closed

Testimonial

  • "Dr Bina is truly amazing. He loves what he does and he does it best."
    Kathy B.