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Practice Name

Justino Chiropractic and Wellness Center

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Primary Location
218 Main Street
New Paltz, NY 12561
Phone: 845.255.5733
Fax: 845.255.5766

Office Hours

DayMorningAfternoon
Monday8:30 - 12:002:00 - 6:00
TuesdayClosed1:30 - 4:00
Wednesday8:30 - 12:002:00 - 6:00
ThursdayClosedClosed
Friday9:00 - 12:002:00 - 6:00
SaturdayClosedClosed
SundayClosedClosed
Main Content

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

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Services We strive to provide complete care for our patients. Learn more about all the services we provide. Make An Appointment We will do our best to accommodate your busy schedule. Schedule an appointment today! Online Forms Our patient forms are available online so they can be completed in the convenience of your own home or office.

Testimonial

Just after my initial visit with Dr. Justino I could feel relief. I feel like I have a new and improved neck and the pain across my back and tightness in my hip has eased. I am happy to say that I feel so much better.

- Bill, age 66


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Office Hours

DayMorningAfternoon
Monday8:30 - 12:002:00 - 6:00
TuesdayClosed1:30 - 4:00
Wednesday8:30 - 12:002:00 - 6:00
ThursdayClosedClosed
Friday9:00 - 12:002:00 - 6:00
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:30 - 12:00 Closed 8:30 - 12:00 Closed 9:00 - 12:00 Closed Closed
2:00 - 6:00 1:30 - 4:00 2:00 - 6:00 Closed 2:00 - 6:00 Closed Closed

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