Lake Shore Chiropractic Center
  • Home
  • About Our Practice
    • Our History
    • Our Professional Chiropractic Team
    • Our Amazing Chiropractic Support Team
    • Organizations We Support
  • Patient Center
    • Patient Information
    • 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
  • Locations
    • Office Locations and Hours
  • Pain Relief Products
    • ChiroFlow Pillows
    • CBD Analgesics
    • Biofreeze
716-646-4000

Established Patient Forms


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Updated Patient Information
  • Fill out all pages if you haven't been here in ​over 3 years
  • Fill out only pages 1 and 2 if its been over a year since you've been here or if you have a new address, insurance, etc...
Adult Form:
ADULT PATIENT INTAKE FORMS
File Size: 233 kb
File Type: pdf
Download File


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​Pain Diagram:  
This gives us a brief history of your chief complaint/s and how it is affecting your daily activities.

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


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Workers' Compensation
Pain Diagram - Re-Injury History
Fill this form out if you experienced an exacerbation/worsening of your existing work related injury.
Detailed Injury/Pain Diagram - Workers Compensation
File Size: 433 kb
File Type: pdf
Download File

Functional Outcome Questionnaires
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​Oswestry Questionairre
- Back Pain

This helps us determine how your condition is affecting your life and helps us track your progress throughout your treatment
oswestry_back_questionairre.pdf
File Size: 24 kb
File Type: pdf
Download File

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​Neck Disability Index (NDI)
- Neck Pain
​
This helps us determine how your condition is affecting your life and helps us track your progress throughout your treatment
neck_disability_index_questionairre.pdf
File Size: 24 kb
File Type: pdf
Download File

Additional Forms

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
    • Patient Information
    • 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
  • Locations
    • Office Locations and Hours
  • Pain Relief Products
    • ChiroFlow Pillows
    • CBD Analgesics
    • Biofreeze