Patient Forms

NEW PATIENTS CLICK HERE
(afterwards, please contact us to schedule your appointment)

Verify My Insurance

New Acupuncture Patient Forms
Informed Consent and Privacy Rights Notification

LCCW Billing Policy

Patient Update Form

ASH Initial Health Status and Member Billing Acknowledgment 

Optum Forms

Back Disability Index

Neck Disability Index

Medicare Forms

Auto Accident Questionnaire

Doctor’s Lien

Assignment & Instructions for Direct Payment

Employee Designation of Personal Chiropractor

Authorization to Release Medical Information