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Secrest Family Chiropractic, PC offers our patient form(s) online so you can complete it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.                       Fax: 480-994-4421

"I want to be your Chiropractor!"

Dr. Daniel P. Secrest, DC  Chiropractic Physician

Note: As with any healthcare treatment/therapy, results are not guaranteed and there are no promises or claims made by the doctor, office staff or the corporation for the cure of any disorder, disease or condition. Chiropractic adjustments and supportive therapies are designed to reduce and/or correct subluxations, allowing the body to return to improved health. 

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

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Lower Back Pain and Disability Questionnaire

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Neck Pain and Disability Index

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General Office Policies

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HIPPA Privacy Policies

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Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

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Our Specialties

New Patients Receive a Complimentary Consultation

THIS ---->https://secrestfamilychiropractic.chiromatrixbase.com/new-patients/online-forms.html

Our Specialties

Applied Kinesiology (KST)

Massage Therapy

Kinesiology Taping

Pregnancy

Office Hours

Day
Monday7:00am7:00pm
Tuesday7:00am7:00pm
WednesdayBy ApptBy Appt
Thursday7:00am7:00pm
Friday7:00am6:00pm
SaturdayClosedClosed
SundayClosedClosed
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
7:00am 7:00am By Appt 7:00am 7:00am Closed Closed
7:00pm 7:00pm By Appt 7:00pm 6:00pm Closed Closed

Client Testimonial

Dr Secrest really cares about his patients. He resolved a 3 year headaches issue for one of my sons that all the other doctors couldn't and he's been fantastic working with my son with autism.

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