New Patient Paperwork

Reception area

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.

We now have interactive online forms as well as PDF versions. Some forms need signatures and only come in the PDF version, please download the forms and records release page by clicking on the links below. Please print all pages of both forms on your home or office printer.  Fill out the forms (to completion) making sure to sign and initial in all locations. Please include a records release form below if you have records, we need to request from another provider or hospital. For auto and work comp add the auto or work comp as well as the doctor’s line.

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.

New Patient Forms (Over 13)

New Patient Forms (Under 13)

Additional Forms


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