Forms for First Visit

Please download and print your intake forms prior to your initial appointment.  If you are unable to have your intake forms before your visit, please arrive at least 15 minutes early to complete the forms in our office.  If you have problems with the files loading, please right click and save to your desktop for printing.

ALL NEW PATIENT VISITS

(Please download and complete the following three form links)

LEC New Patient Medical History

LEC Financial Policy

QVAS and Pain Drawing

 

AND THEN, if these problems relate to you complete the corresponding form.

If you have HEADACHES

Headache Disability Index

If you have NECK PAIN

Neck Pain Disability Index

If you have LOW BACK PAIN

Revised Oswestry Disability Index

 

Other Forms & Information

LEC Clinical Nutrition Policies – for all patients interested in clinical nutrition services at LEC

Modified Elimination Diet