Online Forms

Campbellsburg Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReaderĀ® installed on your computer, Click Here to download.
  • Download the necessary forms, print them out and fill in the required information.
  • Fax us your printed and completed forms or bring it with you to your appointment.

Fax #:  (502)532-0096   

New & Returning Patients Forms

Fill out these documents from home to save time in office. Date paperwork for the date of your appointment. 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! The more information provided, the better we can serve you! 

Download & Print New Patient Forms

DOT Physicals / Medical Certificates 

Fill out these documents to save time in office.  Fill out neatly and completely.  Date paperwork for the date of your appointment.   Tips: bring a medications list that includes the dosage and frequency and be sure you are able to notate which medications is taken for which purpose/condition, bring your glasses if you wear them, avoid consuming foods with large quantities of sugars, salts, and caffeine the morning of your appointment, for best results. 

Download & Print DOT Physical Paperwork

Massage Therapy Forms

Fill out these documents to save time in office. Date paperwork for the date of your appointment. These documents do differ from chiropractic patient documents. 

Please note: Massage therapy appointments are by appointment only. We do ask that you give more than a 24 hour notice if changing or cancelling your appointments. Appointments cancelled with less than a 24 hour notice are subject to a cancellation fee of half the value of the service scheduled for first time cancellations. Second time cancellations are subject to a cancellation fee for the full value of the service scheduled. 

Download & Print Massage Forms

Notice of Privacy Practices

In this document, you will find details on our office Privacy Practices regarding Protected Health Information.

Download & Review This Form


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Office Hours

Our Regular Schedule


8:00 am-1:00 pm

2:00 pm-6:00 pm


10:00 am-2:00 pm


8:00 am-1:00 pm

2:00 pm-6:00 pm




8:00 am-1:00 pm






  • "The level of concern from all members of the staff is above average compared to most health care providers. You are made to feel comfortable and always know where you stand with your progress.
    I came in yesterday in a good deal of pain and today feel 100% better."
  • "Excellent service, excellent treatment......with a very friendly office staff and relaxed atmosphere."
  • "Dr. Mark goes above & beyond to make sure that each & every patient is taken care of & pain free. The staff is very knowledgeable on what they do from the front desk to the patients health. They try to work with the patient as much as they can on getting them in that same day but I know they stay so busy it's not always possible."