Lake Shore Chiropractic Center
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  • 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

New Patient Forms

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New Patient Intake Forms

​Please fill out the form below as it will save you time when arriving to our office and will allow the doctor to review your case prior to seeing you.
​
​Welcome to our office!

To download forms click on the link below:
New Patient Forms
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Adult Form
Fill these forms out if you are new to our practice or if its been over 3 years since you've been here. 
2021_new_patient_intake_forms_lscc.pdf
File Size: 544 kb
File Type: pdf
Download File


​Minor (under 18 years old)- Parental Release
MINOR CONSENT FORM
File Size: 169 kb
File Type: pdf
Download File


Functional Questionnaires
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​Low Back Index - Oswestry
Oswestry Back Questionairre
File Size: 24 kb
File Type: pdf
Download File

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​Neck Disabillity Index
Neck Disability Index Questionairre
File Size: 24 kb
File Type: pdf
Download File


Additional Forms

Motor Vehicle Accident Intake Form
Motor Vehicle Accident Intake Form
File Size: 594 kb
File Type: pdf
Download File


Workers' Compensation/Work Injury Forms​
Workers' Compensation Questionnaire
File Size: 99 kb
File Type: pdf
Download File


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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