Online Forms

Young Chiropractic Bennington 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 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.

For New Patients:

  • New Chiropractic Patient Paperwork – English Version - COMING SOON!
  • HIPAA Notice
  • Financial Policy

     For Returning Patients:

    • Patient Update Form



    Download the Free Adobe Reader®

    Young Chiropractic Bennington

    Address

    15530 Ida Street Suite 400,
    Bennington, NE 68007

    We look forward to hearing from you

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    Please do not submit any Protected Health Information (PHI).

    Monday  

    8:00 am - 6:00 pm

    Tuesday  

    8:00 am - 5:00 pm

    Wednesday  

    8:00 am - 6:00 pm

    Thursday  

    8:00 am - 5:00 pm

    Friday  

    8:00 am - 6:00 pm

    Saturday  

    Closed

    Sunday  

    Closed