Print New Patient Forms
Day 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.
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 FormMember 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 FormDownload the Free AdobeReader®
Workshop / Radio
Join the Fiesta on Tres de Mayo -
We will have food all day catered by Bajio's Mexican Grill on Thursday, May 3rd that you will not want to miss. This is to honor our special for new clients, but also say "gracias" to our current patients. Come join the fun.
View Workshop Videos:
Click on the tab that says videos across the top of our home page, then select educational videos. Click on these words for a sample from one of our videos on Stress.
3D Spine Simulator
Launch 3D Spine Simulator
Advanced Testing
Special for New Clients to our Portland Chiropractic Clinic includes testing shown below and any necessary x-rays!
Nerve Testing:
Normal Surface EMG:
Abnormal Surface EMG:
Abnormal Thermal Scan:
This will allow us to analyze your neural matrix efficiency. We want to bring broadband back to your intelligence system in your body!
Contact
3758 SE 122nd Ave
Portland, OR 97236
Get Directions
- Phone: 503-760-7572
- Fax: 503-760-7567
- Email Us
Our Office Location:
Day Chiropractic
3758 SE 122nd Avenue
Portland, OR 97236
503-760-7572
(just S. of Powell on 122nd)
Special Offer:
Take advantage of our Portland Chiropractic Clinic New Client Special Offer in honor of "Cinco de Mayo" for just $ 23 you will receive a full workup that includes any necessary x-rays from now until May 8th. Call 503/760-7572 to take advantage of this opportunity. If you prefer, email us using this link:
Community Content
Member Wellness
Member Login
Remodeled Clinic
Come see our new "Chiro Cafe" - we want to show that Day Chiropractic is a place of healing and foster a sense of community for all back pain suffers visiting our Portland Chiropractic Clinic seeking Dr. Day's help.
How is your neck?
Normal
or:
Abnormal
We can only know by taking a picture to see. To see is to know, otherwise we are just making a guess. Your health is too important to guess.