Patient Forms

Please print and complete ALL of the following forms prior to coming to your appointment. You may email or fax the forms prior to your appointment, or you  can bring them along with you to your scheduled visit. If you have any questions in regards to the K-Laser or if you prefer to hold off on signing it until you are seen by the provider, please leave blank.

New Patient Intake Form - New Patient Packet (pg 1-2)

Informed Consent to Treatment - New Patient Packet (pg 3)

K-Laser FAQ

K-Laser Consent - New Patient Packet (pg 4)

K-Laser Pain Identification

HIPPA Signature - New Patient Packet (pg 5)

HIPPA Privacy Notice

 

Email: info@chiroassocpa.com

Fax: (717) 299- 4146