Online Forms

If you are like most people, you have a hectic schedule and you’d prefer to minimize the amount of time you need to be in our office on your first visit. We understand and will do our very best to get you on your way in an hour or less!

To further expedite the process, Vitality Chiropractic San Jose offers our intake forms here so you can get they done at your convenience, so you’ll be ready to be seen promptly after your arrival in our office.

  • AdobeReader® is required in order to download your form. If you don’t have it Click Here for a FREE download.
  • Download your Patient Health Record form, print it out and fill it out completely.
  • Fax or email us your completed form or bring it with you on your first appointment.

Patient Health Record – Required

Fill in your Patient Health Record as thoroughly as you can. It is your first communication with the doctor and the more information we have about you, the better job we will be able to do for you. Let us know if you have any questions, comments or concerns!

Download & Print Patient Health Record Form

Download & Print Childrens Health Record Form


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Serving San Jose, Morgan Hill and Surrounding Areas.