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

CONTACT US

We hope to see you soon

  • Family Chiropractic of Lederach, LLC

    658 Harleysville Pike Suite 110,
    Harleysville, PA 19438 US

    Monday:

    8:00 am - 12:00 pm

    3:00 pm - 6:00 pm

    Tuesday:

    3:00 pm - 6:00 pm

    Wednesday:

    8:00 am - 12:00 pm

    3:00 pm - 6:00 pm

    Thursday:

    10:00 am - 12:00 pm

    3:00 pm - 6:00 pm

    Friday:

    Closed

    Saturday:

    Closed

    Sunday:

    Closed

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Please do not submit any Protected Health Information (PHI).

Location

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