To serve you better we ask that you complete your new patient paperwork before your consultation with the doctor. If you have the paperwork finished before you come to your appointment, we can go straight to your consultation with the chiropractor and chiropractic examination. Please use forms below.
Make sure to fill out all five pages and submit the form at the end!
Use this link to fill form on its own page: Link for online paperwork
If you would like to fill the paperwork out online call, text, or email our office and we will explain how to get a link emailed to you. Yes, you can send text messages to our office number (570) 283-1610. Use the contact form on this site to EMAIL US.
Patient forms to Print. (use link above unless you want to print paperwork to fill it out) Old school way
New Patient Forms (Over 13)
New Patient Forms (Under 13)
- Child Health History (PDF printable use with New Patient Form A)
- New Patient Information Form A (PDF printable use both A & Child PDF)
Additional Forms
- Auto Accident Form (PDF Printable Fill out with New patient forms and Doctors Lien)
- Workers Compensation (PDF printable use with New patient forms as Well as Doctors Lien)
- Doctors Lien (Print PDF and Bring with you no online form it needs a signature)
- Records Request (Print PDF and Bring with you no online form it needs a signature)
- HIPAA and office policies can be viewed here.
Mahler Family Chiropractic Center 