Online Forms
Family Life Chiropractic offers our paperwork online, so you can complete it before you arrive at our office in Clearwater, FL. Filling out our patient forms ahead of time may reduce your wait for your appointment with Dr. Jere.
New Patient Form
Download our new patient form below so you can fill everything out ahead of time!
Once you download the form, all you need to do is fill in the required information. From there, feel free to fax or email us your completed form or bring it to your appointment.
Not Sure What Forms You Need? We Can Help!
When you call to schedule your first appointment, we’ll let you know what you need before coming in. If you run into any questions or concerns, please do not hesitate to contact our office! Family Life Chiropractic is more than willing to assist where possible. Give us a call at 727-447-4647 today.