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.
Choose from one of the following, or complete both if you are experiencing back AND neck pain.- Required
3a. Back Pain Questionnaire
3b. Neck Pain Questionnaire
4a. Personal Injury - Motor Vehicle Accident Intake Form - Page 1
4b. Personal Injury - Motor Vehicle Accident Intake Form - Page 2