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Online Forms

East Detroit Chiropractic Center 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 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!

Download & Print Conditions of Acceptance Form

Download & Print New Patient Paperwork 

Download & Print Informed Consent Form

Download & Print Insurance Assignment Form

Download & Print Privacy Practices Acceptance Form

Download & Print Notice of Privacy Practices



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Exclusive Offer

New Patients Receive a Free Consultation

Location

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Office Hours

Our Regular Schedule

SUSAN E. CHALMERS, LMT

Monday:

9:00 AM - 1:00 PM

3:00 PM - 6:00 PM

Tuesday:

9:00 AM - 1:00 PM

Wednesday:

9:00 AM - 1:00 PM

3:00 PM - 6:00 PM

Thursday:

2:00 PM - 6:00 PM

Friday:

2:00 PM - 6:00 PM

Saturday:

9:00 AM - 1:00 PM

Sunday:

Closed

JOHN M. DIMASI, DC

Monday:

9:00 AM - 1:00 PM

3:00 PM - 7:15 PM

Tuesday:

9:00 AM - 1:00 PM

Wednesday:

9:00 AM - 1:00 PM

3:00 PM - 7:15 PM

Thursday:

Closed

Friday:

9:00 AM - 1:00 PM

3:00 PM - 7:15 PM

Saturday:

9:00 AM - 1:00 PM

Sunday:

Closed

THEODORE KOUKLES, DC

Monday:

9:00 AM - 1:00 PM

Tuesday:

9:00 AM - 1:00 PM

3:00 PM - 6:00 PM

Wednesday:

Closed

Thursday:

9:00 AM - 1:00 PM

3:00 PM - 6:00 PM

Friday:

3:00 PM - 6:00 PM

Saturday:

Closed

Sunday:

Closed

STEVEN L. VERGOTE, DC

Monday:

9:00 AM - 1:00 PM

3:00 PM - 7:00 PM

Tuesday:

3:00 PM - 7:00 PM

Wednesday:

9:00 AM - 1:00 PM

3:00 PM - 7:00 PM

Thursday:

9:00 AM - 1:00 PM

3:00 PM - 7:00 PM

Friday:

9:00 AM - 1:00 PM

3:00 PM - 7:00 PM

Saturday:

9:00 AM - 1:00 PM

Sunday:

Closed

RYAN P. MALONEY, DC

Monday:

Closed

Tuesday:

3:00 PM - 7:00 PM

Wednesday:

9:00 AM - 1:00 PM

3:00 PM - 7:00 PM

Thursday:

9:00 AM - 1:00 PM

3:00 PM - 7:00 PM

Friday:

9:00 AM - 1:00 PM

3:00 PM - 7:00 PM

Saturday:

9:00 AM - 1:00 PM

Sunday:

Closed