CONGRATULATIONS on taking the next step toward improved health and wellness!
The following forms are required to be completed prior to your first visit.
There will be additional forms to fill out and sign upon arriving for your initial appointment.
PLEASE: Do Not Date (Your paperwork must be dated for the day of your appointment)!!!
If something is “not applicable” please put “N/A”.
Each check box needs to be checked off individually.
Paperwork must be filled out entirely! Each question must be answered.
Please don't forget your paperwork on your first visit!
Please call or email us with any questions!
Copyright © 2019 Lake Nona Family Chiropractic- All Rights Reserved.
THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT
Disclaimer: The information provided on this website, by Lake Nona Family Chiropractic, is for general use only. Any statement or recommendation on this website does not take the place of medical advice nor is meant to replace the guidance of your licensed healthcare practitioner. These statements have not been evaluated by the Food and Drug Administration. Lake Nona Family Chiropractic information is and products are not intended to diagnose, cure, treat, or prevent any disease or provide medical advice. Decisions to use supplements to support your specific needs should be considered in partnership with your licensed healthcare practitioner.
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