Online Form

At Stratford Chiropractic we take your privacy very seriously and adhere to the highest standards outlined by HIPPA. On this page, you will find the link to our secure web page and find our Confidential Patient Intake Form.

When you click on the link below, you will be directed to a new page where you can print out the Intake Form. Please, fill this form out to the best of your ability and bring it with you to your next appointment. Having this form pre-filled out will save time and allow you the time to gather any additional information you, Dr. Pesale, or any of the other staff of Stratford Chiropractic Spine and Injury Center may need. If you have any questions about these forms or our chiropractic and wellness service call us at (203) 386-9100.

Online forms.