The Lancaster Chiropractor to see - Chiropractor Lancaster

Patient Forms

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms.

A. New Patient

       1. Our Financial Policy [PDF]

       2. Application for Care - Personal History [PDF]

       3. Application for Care - Consultation [PDF]

       4. Acknowledgement of Receipt of Notice of Privacy Practices [PDF]

       5. Fear Avoidance Beliefs Questionnaire [PDF]

B. Insurance Verification

       6. E-Z Patient Insurance Verification [PDF]

C. Update

       7. Clinical History Report [PDF]

D. Areas of Complaint

       8. Headache Disability Index [PDF]

       9. Neck Pain - Pain Scale [PDF]

     10. Back Pain - Pain Scale [PDF]

     11. Knee/Patello - Femoral Questionnaire [PDF]

     12. Carpal Tunnel Syndrome Questionnaire [PDF]

     13. Shoulder Injury Self-Assessment of Function [PDF]

E. Progress Exam

     14. Progress Examination Questionnaire [PDF]

F. Medicare

     15. About Medicare Coverage [PDF]

G. Miscellaneous

     16. Website Membership Enrollment Form 
           Receive complimentary membership to our Members Only section of
           our website. Fill out the form below and return to our office.

     17. Exercise Questionnaire

 

Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Search:

Subscribe to our Lancaster chiropractic newsletter Free Newsletter

Receive free professional health tips on topics that interest you.
 
 
Select Topics:
Backaches & Sciatica
Headaches & Neck Pain
Wellness Topics
Diet & Nutrition
Exercise & Fitness
Women's Health Issues
Children's Health Issues
Stress Management

Dr. James Asks some important questions of interest to Lancaster residents - Chiropractor Lancaster Dr. James Asks...

Can chiropractic cure a child's ear infections?
Chiropractic isn't a cure for anything. Nor is it a treatment for ear infections. However, many children who suffer with ear infections also suffer from spinal problems in their neck, compromising nerves to the ear, depressing the immune system and preventing proper drainage. Can chiropractic help? Find out!
Why does chiropractic work?
Chiropractic works because your nervous system, consisting of your brain, spinal cord and all the nerves of your body, controls and regulates every cell, tissue, organ and system of your body. A chiropractor locates and reduces areas of nervous system compromise (usually along the spine) so your capacity to heal is restored. Chiropractic works by helping your body work as it was designed.