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 Forms >
      • New Patient
      • Established Patient
    • Patient Information
    • Conditions Treated
    • What to Expect on Your First Visit
    • 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
    • Pain Relief Products >
      • ChiroFlow Pillows
      • CBD Analgesics
      • Biofreeze
  • Locations
    • Office Locations and Hours
  • Patient Blog
716-646-4000

New Patient Forms

Picture

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
Picture
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. 
New Patient Forms

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

Informed Consent Form

Please read and sign and/or ask any further questions upon arrival at the office. 

Functional Questionnaires
Picture

​Low Back Index - Oswestry
This helps us determine how your condition is affecting your life and helps us track your progress throughout your treatment
Oswestry Back Questionairre
File Size: 24 kb
File Type: pdf
Download File

Picture

​Neck Disabillity Index
This helps us determine how your condition is affecting your life and helps us track your progress throughout your treatment
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


Proudly powered by Weebly
  • Home
  • About Our Practice
    • Our History
    • Our Professional Chiropractic Team
    • Our Amazing Chiropractic Support Team
    • Organizations We Support
  • Patient Center
    • Patient Forms >
      • New Patient
      • Established Patient
    • Patient Information
    • Conditions Treated
    • What to Expect on Your First Visit
    • 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
    • Pain Relief Products >
      • ChiroFlow Pillows
      • CBD Analgesics
      • Biofreeze
  • Locations
    • Office Locations and Hours
  • Patient Blog