Online Forms

Loertscher Chiropractic Clinic offers our patient form(s) online so you can complete it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Auto and Work Accident - Optional

Pain Chart - Optional

Notice: Patient Privacy - Optional

Terms of Acceptance - Optional