Online Forms

Cerniglia Chiropractic 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.

New Patient Intake 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!

Form 1: Download & Print Form Patient Intake Form


Auto Accident Questionnaire - Both are Required

Please fill out both forms in addition to the forms found above in the New Patient Health History section.

Form 1: Download & Print Form Auto Accident Questionnaire

Form 2: Download & Print Form NYS No-Fault AOB


Worker's Compensation Questionnaire

Please fill out both forms in addition to the forms found above in the New Patient Health History section

Form 1: Download & Print Form Workers Comp Questionnaire 

Form 2: Download & Print Form A-9 Form


Privacy Policy

Download & Print Form



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Locations

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Office Hours

Latham Office

Monday:

12:00 pm-7:00 pm

Tuesday:

7:00 am-4:00 pm

Wednesday:

10:00 am-7:00 pm

Thursday:

7:00 am-3:00 pm

Friday:

7:00 am-3:00 pm

Saturday:

8:00 am-11:00 am

Sunday:

Closed

Scotia Office

Monday:

7:00 am-12:00 pm

2:30 pm-6:00 pm

Tuesday:

7:00 am-12:00 pm

2:30 pm-5:00 pm

Wednesday:

7:00 am-12:00 pm

2:30 pm-5:15 pm

Thursday:

8:00 am-12:00 pm

3:00 pm-6:00 pm

Friday:

7:00 am-12:00 pm

2:30 pm-4:30 pm

Saturday:

9:00 am-12:00 pm

Sunday:

Closed

Testimonial

  • "He provided excellent and thorough care. I highly recommend Dr. Cerniglia."
    Brian S Navarro, M.D. - Scotia, NY