Online Forms

Active Chiropractic & Rehabilitation offers our patient form(s) 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 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 Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form



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We look forward to hearing from you

Location

Serving Safety Harbor, Clearwater, & Tampa Bay area

Office Hours

Our Regular Schedule

Monday:

9:00 am-6:30 pm

Tuesday:

9:00 AM-1:00 PM

By Appointment

Wednesday:

9:00 am-6:30 pm

Thursday:

9:00 AM-1:00 PM

By Appointment

Friday:

Administration Hours

Saturday:

Closed

Sunday:

Closed