Call For Your Appointment: 716 -681-3333

Forms Library

for Your Appointment at Lancaster Depew Chiropractic

Part 1

Skip the paperwork in the office, and download our new patient forms!

Please print and fill out all forms pertaining to you, as they are mandatory for your insurance.

Empire/United Health Insurance:

New Patient Policy
Empire/United Health Care
Minor Consent Form

Medicare/Base:

New Patient Policy
Medicare/Base
Minor Consent Form

All Other Insurances/Cash:

New Patient Policy
All Other Insurances / Cash
Minor Consent Form

Motor Vehicle/ Personal Injury:

New Patient Policy
Motor Vehicle/ Personal Injury
Minor Consent Form

Workers
Comp:

New Patient Policy
Workers Compensation
Minor Consent Form

Part 2

If you are experiencing Low back pain, please print and fill out the Low Back Pain Charts 1 & 2.

If you are having neck pain, please print and fill out the Neck Pain Chart.

If you are experiencing headache pain, please print and fill out the headache form.

If you having pain in all three areas, please print and fill out all 4 forms.

Low Back Pain Forms:

Low Back Pain Chart 1
Low Back Pain Chart 2

Neck Pain Form:

Neck Pain Chart 1

Headache Form:

Headache Pain Chart 1

Re-Exam Forms

 re-exam Form:

re-exam Form