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Scotia

518-374-8039

518-218-4455
Latham
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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 for All Patients

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 (Required for No-Fault Insurance only)

Please fill out both forms in addition to the form found above in the New Patient Intake Form section.
Form 1: Download & Print Form Auto Accident Questionnaire
Form 2: Download & Print Form NYS No-Fault AOB

Worker's Compensation Questionnaire (Required for Worker's Compensation only)

Please fill out both forms in addition to the form found above in the New Patient Intake Form section
Form 1: Download & Print Form Workers Comp Questionnaire 
Form 2: Download & Print Form A-9 Form

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Location

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Office Hours

Latham Office
Monday:
10:00 am - 07:00 pm
Tuesday:
07:00 am - 04:00 pm
Wednesday:
07:00 am - 03:00 pm
Thursday:
07:00 am - 03:00 pm
Friday:
07:00 am - 03:00 pm
Saturday:
Closed
Sunday:
Closed

Office Hours

Scotia Office
Monday:
07:00 am - 12:00 pm
02:30 pm - 06:00 pm
Tuesday:
02:00 pm - 04:15 pm
Wednesday:
07:00 am - 12:00 pm
02:30 pm - 06:00 pm
Thursday:
08:00 am - 12:00 pm
Friday:
07:00 am - 12:00 pm
02:30 pm - 04:30 pm
Saturday:
09:00 am - 12:00 pm
Open Two Saturdays/Month
Sunday:
Closed

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Please do not submit any Protected Health Information (PHI).
Testimonial
"He provided excellent and thorough care. I highly recommend Dr. Cerniglia."
Brian S Navarro, M.D. - Scotia, NY