Lake Shore Chiropractic Center
  • Home
  • About Our Practice
    • Our History
    • Our Professional Chiropractic Team
    • Our Amazing Chiropractic Support Team
    • Organizations We Support
  • Patient Center
    • Conditions Treated
    • What to Expect on Your First Visit
    • Patient Forms >
      • New Patient
      • Established Patient
    • Insurances Accepted
    • Payment and Fees
    • Office Hours and locations
    • Products
  • Services
    • Chiropractic Manual Manipulation
    • Active Release ART
    • Cox's Distraction
    • McKenzie Methods
    • Graston/IASTM Techniques
  • Contact Us
    • Office Locations and Hours
  • Pain Relief Products
    • CBD Analgesics
    • Biofreeze
716-646-4000

Established Patient Forms


Updated Patient Information
(every 3 Years)
​
Patient Intake Form
File Size: 233 kb
File Type: pdf
Download File

Pain Diagram:
Detailed Injury/Pain Diagram
File Size: 433 kb
File Type: pdf
Download File

Workers' Compensation
Pain Diagram - Re-Injury History
Detailed Injury/Pain Diagram - Workers Compensation
File Size: 433 kb
File Type: pdf
Download File


​Palladium Forms For Univera Patients
Adult Form
palladian_chief_complaint_form.pdf
File Size: 24 kb
File Type: pdf
Download File

Pediatric Form
palladian-_pediatric_form.pdf
File Size: 24 kb
File Type: pdf
Download File

Functional Outcome Questionnaires

​
​Oswestry Questionairre - Back Pain
oswestry_back_questionairre.pdf
File Size: 24 kb
File Type: pdf
Download File

​
​Neck Disability Index(NDI) - Neck Pain
Additional Forms
neck_disability_index_questionairre.pdf
File Size: 24 kb
File Type: pdf
Download File


Motor Vehicle Accident Form

​Workers' Compensation/Work Injury Forms
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  • Home
  • About Our Practice
    • Our History
    • Our Professional Chiropractic Team
    • Our Amazing Chiropractic Support Team
    • Organizations We Support
  • Patient Center
    • Conditions Treated
    • What to Expect on Your First Visit
    • Patient Forms >
      • New Patient
      • Established Patient
    • Insurances Accepted
    • Payment and Fees
    • Office Hours and locations
    • Products
  • Services
    • Chiropractic Manual Manipulation
    • Active Release ART
    • Cox's Distraction
    • McKenzie Methods
    • Graston/IASTM Techniques
  • Contact Us
    • Office Locations and Hours
  • Pain Relief Products
    • CBD Analgesics
    • Biofreeze