Great Lakes Chiropractic

We have included some of our forms for your convenience.  You can fill them out in the comfort of your own home and bring them to your first visit. These forms will also be available in our office when you arrive.

What you should bring to your 1st appointment

Any insurance information you may have.
A picture ID or driver’s license.
Any X-rays, MRI’s and/or other testing if applicable.
Patient History form



New Patient History Form - REQUIRED  for any New Patient

You may print and fill out this form and bring it in with you to save time on your first visit.

This is required for any patient regardless of age, condition, or injury. If you forget to bring it, that's okay, we have time for you to fill it out when you get here.

Download & Print Form


Consent to Treat a Minor Form

Are you a current patient not available to bring your minor child in? If you would like for another adult or your own child to come in for an initial visit without you, you may print and sign the consent form.

Download & Print Form


Auto Accident Injury Form or Work Accident Form

Were you injured in an auto or work accident? If you have and are billing your services to one of them, please fill out the applicable an Auto Accident Form or a Work Comp Authorization Form and bring it with you to your appointment. We require prior authorization from the responsible party/insurance company to submit claims. Please report your accident and obtain permission before your scheduled appointment to avoid delays.

Auto Accident Form - Download & Print Form

Work Comp Authorization Form - Download & Print Form


INSURANCE INFORMATION / FINANCIAL INFO /HIPAA Privacy Act Form - REQUIRED

Review our financial policy as well as give us your insurance information.

We are compliant with the Health Insurance Portability and Accountability Act.

Download & Print Form


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Office Hours

Monday

8:00 am - 6:00 pm

Tuesday

8:00 am - 6:00 pm

Wednesday

8:00 am - 6:00 pm

Thursday

8:00 am - 6:00 pm

Friday

8:00 am - 6:00 pm

Saturday

8:00 am - 12:00 pm

Sunday

Closed

Monday
8:00 am - 6:00 pm
Tuesday
8:00 am - 6:00 pm
Wednesday
8:00 am - 6:00 pm
Thursday
8:00 am - 6:00 pm
Friday
8:00 am - 6:00 pm
Saturday
8:00 am - 12:00 pm
Sunday
Closed

Location

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