Serving the community with personalized Healthcare
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Downloads
For your convenience we have installed our initial visit office paperwork here.
If you are a new patient to our office please download, print and complete the New Patient Information and the Welcome paperwork . Please read our HIPAA Privacy Policy and print and sign the HIPAA Waiver.
If you are seeking care for an automobile accident please download, print and complete that paperwork
as well as the other paperwork outlined above.
Please bring your completed paperwork to Le Bel Chiropractic at the time of your first appointment.
Thank YOU! We look forward to meeting you soon.
New Patient Information
Information about you. Please download, print and fill out completely. Please bring with you at your first appointment.
Welcome
Health history. Please download, print and complete fully and bring with you to your first office.
HIPAA Release & Waiver for Information
This waiver will alllow our staff to collect pertinent health information including x-ray and other diagnostic reports in advance of your first appointment for the doctor's review. Please download, print and sign in all places and bring with you at the first appointment.
Automobile Injury
Auto questionnaire. Please also supply us with information at the bottom of the form regarding your insurance company, address, telephone and contact person. If you have retained an attorney, please also note their name, address and phone. |