New Patient Paperwork

Welcome to Stucky Chiropractic Center!

Congratulations for making an excellent decision in selecting Stucky Chiropractic Center to help you meet your health goals!

When you first arrive, we will have a short form for you to complete.  The New Patient Forms are available to download (below) and print. Completing these forms prior to your visit will save you time in our office. They are very simple and will help give your chiropractor the information he or she needs to better serve you.  You will then have an initial consultation with your doctor to discuss your health concerns and goals and to determine the best plan for you!

Please bring your insurance card(s) with you (if applicable). As a courtesy to you, we will call to find out what your benefits may cover. We encourage you to call your insurance company ahead of time to verify coverage. Every policy is different, so we cannot guarantee how they will cover your care in our office. We also offer great, affordable cash rates and family plans.

Download Forms

New Patient Registration

Personal information needed to accurately fill out your health records and to perform services.

Download
New Pediatric Patient Registration Form

Personal information needed to accurately fill out your child’s health records and to perform services.

Download
Consent to Treat a Minor Child Form

This form is required for children under the age of 18 and is consent for Stucky Chiropractic Center to treat your child.

Download
Worker’s Compensation Form

This form is required in addition to the New Patient Registration Form if your treatment is due to a Worker’s Compensation Claim.

Download
Auto Accident Form

This form is required in addition to the New Patient Registration Form if your treatment is due to an Auto Accident Claim.

Download
Ideal Protein Health Profile

Health Profile for new & existing Ideal Protein customers.

Download
Records Release Form

This form is required if patient is requesting the release of medical records and/or x-rays.

Download
Patient Success Written and Video Testimonials

If you wish to share your experience at Stucky Chiropractic Center, please fill out this form.

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