Patriot Chiropractic Center   

Dr. Steven Bernabeu & Dr. Gina Simonetti

New Patients:

Do not let filling out paperwork get in the way of a great appointment! Please complete and bring with you the first five documents and consent to treatment of a minor if applicable. If you are unable to print the forms, please arrive 15 minutes before your scheduled appointment  time to complete them in office. 



New Patient Forms:

- Patient Registration  (download)
- Patient Case History (download)
- Email and/or Text Consent    (download)
- HIPPA Notice of Privacy Practices  (download) 
- Office Policy (download)


- Consent to Treatment of a Minor    (download)


Additional Patient Forms:

- Please contact the office for access to documents specific to your situation, such as Medical Records Release, Contact Information Update Form, Nutritional Assessment, or Nutritional Questionnaire.