Online Forms

Ajax Family Chiropractic offers our new patient form(s) online so you can complete them in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • You can complete the form(s) online and print them out or Download the form(s), print them out and fill in the information by hand.
  • Bring your completed form(s) to your first appointment and you will save yourself some time.

New Patient Health History Form - Required

This information lets us know about you --- your health history and your current state of health.

Come with your questions, concerns, or goals regarding wellness and we will do our best to help.

Forms are fillable, so fill them in and print them or print the form and fill in by hand, it's your choice

Adult Form (Click to Open & Print)

Child Form - 12 & under (Click to Open & Print)

Download the Free AdobeReader®


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Office Hours

Our Regular Schedule

Ajax Office


7:45 am-11:00 am

3:00 pm-7:00 pm


7:45 am-12:30 pm

3:00 pm-6:00 pm


7:45 am-11:00 am

3:00 pm-7:00 pm


7:45 am-12:30 pm

3:00 pm-7:00 pm




9:00 am-12:00 pm




Reviews By Our Satisfied Patients

  • "Dr. Mark and Dr. Mike are both dedicated doctors who go out of their way for their patients, and are constantly striving to provide the best care possible. Highly recommended!"
    Byron M.
  • "I've known Dr. Mark and Dr. Mike for more than a decade now. I have always been so impressed by them and their commitment to the people they serve. They are truly gifted Doctors and healers! Thanks Dr. Mike and Dr. Mark for all you do for me and so many others!"
    Mark F.