New Patient Information, 4 page form (2012 revision)
All new patients are required to complete our Patient Information form, prior to any treatment. The form
includes a medical history portion. Click on the icon to the left to open the form in Adobe and then print
the four (4) page document. Bring your completed form to the office on your first visit, this will greatly
reduce your time in the waiting room.
Existing patients: if there has been a substantial change in your personal information, you may be asked
to resubmit a new form, particularly when there has been a change in your health history.
Injury incurred from Motor Vehicle Accident, 5 page form
In addition to the new patient form listed above, if your ailment is related to or a result of a motor vehicle
accident, then you will be required to complete this five (5) page form prior to treatment. Click on the
icon to the left to open the form in Adobe and then print the document. Bring your completed form to the
office on your visit.
©2008-12 All rights reserved Julington Creek Chiropractic & Wellness Center, P.A.
Dr. Thomas F. Lahmann, Chiropractic Physician
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