New Patient Forms

If you are a New Patient who has scheduled an appointment at Scranton Clinic of Chiropractic please use this link to fill out our on-line New Patient information. You will need the PIN number the staff gave you when you called to schedule your appointment.

New Patient Online Portal

Feel free to download and print the forms, fill them out and bring them with you to your appointment. Download and print what you need to make your visit easier.

New Patient Form – PDF Download
Pediatric New Patient Form – PDF Download


Existing Patient Online Portal

Established Patients can view scheduled appointments, update contact information and print receipts. Please use your patient PIN number to access your account information.

Existing Patient Online Portal

Fibromyalgia Forms

Our Fibromyalgia patients will need to fill out the Fibromyalgia Impact Questionaire. You can learn more about Fibromyalgia and our Fibromyalgia treatment plans by clicking here.

Download and print the form below.

Fibromyalgia Questionaire – PDF Download
Fibromyalgia Stories – PDF Download


Fibromyalgia Appointments

Call Dr. Scranton’s Fibromyalgia Hotline at (801) 571-1338 to schedule an appointment.

If for any reason you are not able to download the above forms, please contact our office for assistance.

Terms and Conditions

The above forms are for the use of persons seeking care at Scranton Clinic of Chiropractic. All coupons MUST be presented during first visit to receive discount. No exceptions. Any discounted x-rays remain the property of Scranton Clinic of Chiropractic unless paid in full. Medicare exclusions may apply.