Lemont Natural Healthcare offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.
1. Chiropractic Registration Form (2 pages) - Required
2. New Patient Intake Form(2 pages) - Required
Please complete one intake form for EACH area of complaint.
Please complete any of the following that apply. (EACH form should correspond with an intake form #2.) - Required
3a. Back Pain Questionnaire
3b. Neck Pain Questionnaire
3c. Upper Extremity Pain Questionnaire
3d. Lower Extremity Functionality Scale