625 Ayrault Rd.

Fairport, NY 14450 US

585-598-3535

Online Forms

Derleth Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.

New Patient Intake 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!

New Patient Intake Click here


Pediatric Intake Form

Intake Form


Download the Free AdobeReader®

Sign up now for a free consultation!

Office Hours

Monday:

Closed

Closed

Tuesday:

8 AM

7 PM

Wednesday:

8 AM

5 PM

Thursday:

8 AM

7 PM

Friday:

8 AM

2 PM

Saturday:

Closed

Closed

Sunday:

Closed

Closed

Location

Testimonial

  • "Dr. Phil is a gentle, kind, and astute practitioner. He is friendly, always runs on time, and I'm thankful for giving chiropractic care a try. Staff is always pleasant, the office is clean, relaxing, and inviting. Highly recommend!"
    Erin S. / Fairport, NY

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