Active Care Chiropractor

6800 Pittsford-Palmyra Rd
Building 200, Suite 220
Fairport, NY 14450

Phone: 585-598-3458
Fax: 585-598-3459

Patient Forms

Please take a moment to fill out your intake paperwork online before you come into the office for your first visit.  We have tried to make the process as easy as possible.  


  1. Click the link below and you will be taken to the paperwork page.
  2. Fill in the requested information as completely as possible. 
  3. When you are finished with the form, sign with your mouse and click “submit.” 


That’s it! You are finished! There is no need to print your forms as the information will be securely delivered to our system and should be ready for your first visit.


Click the link below to get started! Feel free to call the office if you have any questions or difficulty.


New Patient Intake


Connect with Us!



6800 Pittsford-Palmyra Rd. Suite 220 - Fairport, NY 14450
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