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In order to streamline your visit, Wellness One of South Bergen /Family Chiropractic Center offers patient forms online that can be completed at your convenience before you arrive in our 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 health history form is the starting point of our first visit, please fill it out to the best of your ability, spelling is not important, but dates, procedures and injuries are critical information.

Download & Print Form(a)
Download & Print Form(b)


New Acupuncture Patient Health History Form - Required for New Acupuncture Patients

This health history form is the starting point of our first visit, please fill it out to the best of your ability, spelling is not important, but dates, procedures and injuries are critical information.

Download & Print Form


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. Click Here to register online now! 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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Wellness One proudly carries AlignLife nutritional products and supplements. Click the button for more information.

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Contact The Chiropractor

Wellness One of South Bergen - Family Chiropractic Center

186 Paterson Ave East Rutherford, NJ 07073
Phone: 201-933-3040
Fax: 201-933-8611

Business Hours

Day Morning Afternoon
Mon-Fri 9am - 1pm 3pm - 7pm
Sat Appointment Only
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