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Miano Family Chiropractic Center, LLC offers our patient form(s) online so they can be completed it in the convenience of your own home or 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 Registration Form - Required

Please take your time and fill out this form as completely as possible.  This supplies our office with the personal and insurance information necessary to become a new patient.

Download & Print Form


New Patient Health History Form - Required

Please be sure to fill out all pages of the form(s) completely.  This allows us to gather the information needed to properly analyze your condition and recommend appropriate care.

Chiropractic Intake Form (Adult): Download & Print Form

Chiropractic Intake Form (Pregnancy): Download & Print Form

Chiropractic Intake Form (Pediatric): Download & Print Form

Acupuncture Intake Form: Download & Print Form


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



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Exclusive Offer

Welcome New Patients!

THIS ---->https://drjennifermiano.com/new-patient-center/online-forms.html

Office Hours

DayMorningAfternoon
Monday10:00am - 12:45pm3:00pm - 6:30pm
TuesdayClosedClosed
WednesdayBy Appointment3:00pm - 6:30pm
ThursdayClosedClosed
Friday10:00am - 12:45pm3:00pm - 6:30pm
Saturday10:00am - 12:00pm*Closed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
10:00am - 12:45pm Closed By Appointment Closed 10:00am - 12:45pm 10:00am - 12:00pm* Closed
3:00pm - 6:30pm Closed 3:00pm - 6:30pm Closed 3:00pm - 6:30pm Closed Closed

Testimonial

We value our patients' experience at the Miano Family Chiropractic Center, LLC. If you are currently a patient, please feel free to complete the following Chiropractic and/or Acupuncture Questionnaire. Please bring in your completed form to let us know what you think! They are in Adobe Acrobat format, and requires the free Acrobat Reader to view.

Download & Print Questionnaire

Jennifer L. Miano, DC, CACCP
Family Chiropractic Physician
Miano Family Chiropractic Center, LLC | 201-746-0640

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