Online Forms

Family Chiropractic of Lederach, LLC offers these forms online to be completed at your convenience. Complete ONLINE or print and bring to the office with you for your first visit, along with your insurance card and photo ID.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print out and fill in the required information

1) To submit ONLINE for CHIROPRACTIC, click HERE for case history AND also Download and read Patient Policies.

PLEASE NOTE: IF QUESTIONS MARKED WITH AN ASTERISK (*) ARE NOT COMPLETED, THIS FORM WILL NOT BE FORWARDED TO OUR OFFICE.

2) To PRINT Forms for CHIROPRACTIC:

Download, print, complete and bring to the office.

     AND    3) Download and read for New Patient Policies Chiropractic care 

4) PRINT for MASSAGE, complete and bring to the office. 24 hour cancellation requested for massage. (charge may apply)

5) PRINT for REFLEXOLOGY, complete and bring to the office. 24 hour cancellation requested for reflexology. (charge may apply)

Need to contact us? Enter the information below or call 215-256-8006

Location

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Office Hours

Note that we are only in select Saturdays. Please call the office for more information.

Monday:

9:00 am-7:00 pm

Tuesday:

3:00 pm-7:00 pm

Wednesday:

9:00 am-7:00 pm

Thursday:

10:00 am-7:00 pm

Friday:

9:00 am-6:00 pm

Saturday:

9:00 am-11:00 am

Sunday:

Closed