The blue link below will direct you to the forms and waivers required for all new patients.
IMPORTANT – PLEASE READ:
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.