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Patient Forms

We offer our paperwork online, in convenient .pdf format that you can print and complete prior to your appointment.


New Patient Forms

This lets us know what’s happened with your health, but perhaps more important, where do you want to take your health?

PDF IconNew Patient Forms (6 years and older)

PDF IconNew Patient Forms (Infant – 5 years)

Medicare New Patient Form

PDF IconMedicare New Patient Forms

Personal Injury / Car Accident Forms

PDF IconPersonal Injury / Car Accident Forms

Nutritional Assessment (optional)

If you’re interested in a free nutritional assessment to determine any specific supplement and/or chiropractic needs in different areas of your body, you can fill out this form and bring it in to your appointment.

PDF IconSystems Survey Form

Medical Release Form

If you need a copy of your X-rays or Patient Notes, we require a signed medical release. Once completed, you may bring it to the office or scan and email to patients@labountychiropractic.com

PDF IconMedical Release of Records

LaBounty Family Chiropractic Forms | (515) 965-8280