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!Download & Print Form
Auto and Work Accident - OptionalDownload & Print Form
Pain Chart - OptionalDownload & Print Form
Notice: Patient Privacy - OptionalDownload & Print Form
Terms of Acceptance - OptionalDownload & Print Form
Download the Free AdobeReader®