Pickaway Chiropractic Center in Circleville OH
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    • Virtual Office Tour
    • What To Expect
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    • Forms
  • Meet The Doctor
    • Dr. Joshua Dick D.C. C.C.E.P.
  • Massage Therapy - Jessica Rossiter L.M.T.
  • Hours and Location
  • What is Chiropractic?
    • How can Chiropractic Help?
    • Subluxation
    • Adjustment
    • Spinal Decay
    • Pregnancy & Chiropractic
    • Children & Chiropractic
    • Athletes & Chiropractic
    • Chiropractors I Recommend
  • Schedule an Appointment

 Here are the basic forms for new patients.  Please download and fill out the Adult History Form, Financial Policy Form, and the Informed Consent.  If your child has an appointment with us download the Child History Form instead of the Adult History Form.  If you have any questions regarding the forms please give us a call  or we can address them at your appointment. 

New Patient Form
File Size: 143 kb
File Type: pdf
Download File

Please print and fill out this form completely.

For all patients 
Financial Policy
File Size: 11 kb
File Type: pdf
Download File

This form covers our office financial policies.  Please read and sign, if you have any questions, feel free to call or ask at the time of your appointment.

For all patients
Informed Consent
File Size: 4 kb
File Type: pdf
Download File

Please read over this form and bring with you.  We will discuss treatment options and any questions you have. 

For all patients
Child History
File Size: 10 kb
File Type: pdf
Download File

This form is for our pediatric (under 7) patients.  Please fill out completely for your child and bring with you.
Pickaway Chiropractic Center in Circleville Ohio 778 North Court Circleville OH Phone:(740) 474 - 5352 Email: pickawaychiro@yahoo.com Dr. Joshua Dick D.C. C.C.E.P.