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Skocik Chiropractic 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.

Phone: (717) 540-8448
Fax: 717-540-6233


New Patient Form - Required

Download & Print Form or Click Here for Electronic Version


Disclosure of Health Information / HIPPA - Overview of full HIPPA compliant policy

Download & Print Form


Auto Accident Questionnaire - Only fill out if experiencing auto accident injury

Download & Print Form


Work-Related Injury Questionnaire - Only fill out if experiencing work related injury

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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Find out now whether careful, professional, chiropractic care can relieve your aches and pains. We offer you a complimentary preliminary spinal examination and a report of our findings. The preliminary examination consists of a neurological test, a spinal alignment check, a muscle test, a blood pressure test as well as a private discussion with the doctor to discuss your results.

This examination is entirely FREE!

** Due to Federal Regulations,
This offer does not apply to
Medicare/Medicaid. **

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

Office Hours

Day
Monday8am-12pm3pm-6pm
Tuesday8am-12pm3pm-6pm
Wednesday8am-12pm3pm-6pm
Thursday8am-12pm3pm-6pm
Friday8am-12pm3pm-6pm
SaturdayClosedClosed
SundayClosedClosed
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8am-12pm 8am-12pm 8am-12pm 8am-12pm 8am-12pm Closed Closed
3pm-6pm 3pm-6pm 3pm-6pm 3pm-6pm 3pm-6pm Closed Closed

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