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Online Forms

Lake Cities Chiropractic Ctr. offers our patient form(s) online so they can be completed 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.

If you would like to have your insurance verified please click here.

New Patient Health History Forms  (This packet is required for all new patients.) We have them broken down into case types, please choose one of the following packets below.

1.  Cash Patients   Click Here
2.  Insurance/ Major Medical Policies   Click Here
3.  Medicare Patients   Click Here
4.  Auto Accident/Injuries (Non-Workers Compensation)   Click Here

Health Records Release Form

Download & Print Form

Pain Questionnaires Forms 

Download & Print Form

Wellness Analysis Packet

Download & Print Form

Aromatherapy Questionnaire & Ion Cleanse Footbath Release Form

1.  Aromatherapy Questionnaire  Click Here
2.  Ion Cleanse Release Form     Click Here

My Chiropractic Story Form

Download & Print Form

Marketing Packet Handout 

Download & Print Form

Satisfaction Survey Form

Download & Print Form

Download the Free AdobeReader®


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Office Hours

Our Regular Schedule

Lake Cities Chiropractic Ctr.


8:00 am - 1:00 pm

3:00 pm - 6:00 pm


12:00 pm - 7:00 pm


8:00 am - 1:00 pm

3:00 pm - 6:00 pm


12:00 pm - 6:00 pm


8:00 am - 1:00 pm

3:00 pm - 6:00 pm






  • "Words of gratitude seem so inadequate describing the professional treatment/relief and expertise I have received."
    Walt H. - USAF (Ret.)