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Request Appointment

814-736-9897

Portage Chiropractic 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 Welcome Form - Required

Download & Print Form


Consent Form - Required

Download & Print Form


Activities of Daily Living Form - Required

Download & Print Form

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VAS Diagram Form- Required

Download & Print Form




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