Online Forms


Lemont Natural Healthcare offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

1. Chiropractic Registration Form (2 pages) - Required

Download & Print Form


2. New Patient Intake Form(2 pages) - Required

Please complete one intake form for EACH area of complaint.

Download & Print Form

Please complete any of the following that apply. (EACH form should correspond with an intake form #2.) - Required

3a. Back Pain Questionnaire

Download & Print Form

3b. Neck Pain Questionnaire

Download & Print Form   

3c. Upper Extremity Functional Index

Download & Print Form

3d. Lower Extremity Functionality Scale

Download & Print Form


4a. Personal Injury - Motor Vehicle Accident Intake Form - Page 1

Download & Print Form

4b. Personal Injury - Motor Vehicle Accident Intake Form - Page 2

Download & Print Form


Download the Free AdobeReader®

Locations

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HOURS OF OPERATION

Monday

9:00 am - 7:00 pm

Tuesday

Closed

Wednesday

9:00 am - 7:00 pm

Thursday

Closed

Friday

9:00 AM - 7:00 pm

Saturday

Closed

Sunday

Closed

Monday
9:00 am - 7:00 pm
Tuesday
Closed
Wednesday
9:00 am - 7:00 pm
Thursday
Closed
Friday
9:00 AM - 7:00 pm
Saturday
Closed
Sunday
Closed