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This form is for new patients to establish contact with the office:

Please do not include any PHI (Private Health Information) in the message.  

Let us know what days (TUES/WED/FRI/SAT) work for you and whether you prefer morning, afternoon, or a specific time.

Using the provided phone number, we will call you back during business hours if you indicate you would like an appointment. 

Email addresses will be used to provide you with intake paperwork should you schedule an appointment. 

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I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

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Kiehart Chiropractic Logo depicting key, heart, and hands. Established 2023 visible on logo.

Practice Location: 228 W. Main St. Montour Falls, NY 14865

        Telephone: 607-210-6069

Fax: 607-749-5422


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