5431 Jonestown Rd

Harrisburg, PA 17112 US

(717) 540-8448

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Online Forms

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



Download the Free AdobeReader®

This examination is entirely FREE!

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

Office Hours

Our Regular Schedule

Monday:

8:00 am - 12:00 pm

3:00 pm - 6:00 pm

Tuesday:

8:00 am - 12:00 pm

3:00 pm - 6:00 pm

Wednesday:

8:00 am - 12:00 pm

3:00 pm - 6:00 pm

Thursday:

8:00 am - 12:00 pm

3:00 pm - 6:00 pm

Friday:

8:00 am - 12:00 pm

3:00 pm - 6:00 pm

Saturday:

Closed

Closed

Sunday:

Closed

Closed

Location

Find us on the map

Testimonials

Reviews By Our Satisfied Patients

  • "Skocik Chiropractic was very personable and informative. Dr. Skocik and his staff purposefully takes care of their patients with attentiveness and professionalism. I enjoyed my time there and highly recommend Skocik Chiropractic."
    B, Wanda

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