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809 N. State St. Ephrata, PA 17522

Burkholder Chiropractic Clinic offers our patient forms online so they can be completed 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 forms, print them out and fill in the required information.
  • Fax us your printed and completed forms or bring them with you to your appointment.

New Patient Forms

For your convenience you may print and complete your intake paperwork at home.  Please complete all sections of these forms.  Remember to bring the forms, a photo ID and your health insurance card(s) with you to your appointment.

Click Here to Print & Complete Intake Paperwork


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