2016 Justin Road, Ste 310, Highland Village TX 75077 972-966-1600

LFC Adult New Patient Evaluation

The blue link below will direct you to the forms and waivers required for all new patients.

Once you have filled out all of the required fields (highlighted in red) accurately, a box will appear on the left side of the screen with a yellow button to click to “Confirm Signing”.  If that box does not appear, then the required fields have either not been filled out correctly, or you have missed a place.  Please go back through the forms carefully to make sure that all fields are filled in according to the requirements.

NOTE: If you exit out of this form before clicking “Confirm Signing”, the document will not be saved.

If you need assistance with this form, please call 866-219-4318.

Please click on the link below if you are a new Lomonaco Family Chiropractic patient ages 12 or older.


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