Online Forms





Steven Chierchie, D.C. 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.

  • 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.

Patient Forms- 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!

New Patient Forms 

For Medicare Patients Only: Medicare ABN

Privacy Practices: Privacy Practices


Download the Free AdobeReader®

Sign-up using the form or call us at 631-765-5151 to make your appointment today!

Office Hours

Our Regular Schedule

Steven Chierchie, D.C.

Monday:

8:00 am - 12:30 pm

2:30 pm - 6:00 pm

Tuesday:

10:30 am - 1:00 pm

Closed

Wednesday:

8:00 am - 12:30 pm

2:30 pm - 6:00 pm

Thursday:

Emergencies only

Friday:

8:00 am - 12:30 pm

2:30 pm - 6:00 pm

Saturday:

8:00 am - 12:30 pm

Sunday:

Emergencies only

Location

Find us on the map

Testimonial

  • "Great Chiropractor!"
    Donna T.

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