New Patient Form for Initial Visit

For your convenience, and to save you time, please find the New Patient Information Form available for downloading and printing.  Please fill out the form and bring it to the office on your initial visit.  Also, please find our HIPPA Policy available for your viewing and downloading.

New Patient Form

  Download & Print Form

HIPAA Policy

  Download & Print Form


Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.


New Patients Seen Same Day




Pittsburgh Chiropractic Associates
Dr. Wallace Shaffer
355 5th Ave, Suite 1325
Pittsburgh, PA
Phone: (412) 325-1585
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