Westenhaver Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know! Please download and print each of these links below.
Intake forms 1
Intake forms 2
Privacy Policy
General Insurance and Self Pay forms - Please print these forms in addition to the intake forms if we will be billing your general health insurance or you will be paying out of your pocket for all services rendered.
General Insurance/Self pay Forms
Medicare Forms- Please print the following forms out in addition to the intake forms if we will be billing Medicare for you.
Medicare Form 1
Medicare Form 2
Workers Compensation Form - Please print the following forms out in addition to the intake forms if we will be billing a work compensation insurance for you.
Work Compensation Forms
Auto Accident Form - Please print the following forms out in addition to the intake forms if we will be billing for an auto accident for you.
Auto questionnaire
Auto accident forms 1
Auto accident forms 2
Monday: 8:00 am - 11:00 am | 3:00 pm - 6:00 pm
Tuesday: closed
Wednesday: 9:00 am - 11:00 am | 3:00 pm - 6:00 pm
Thursday: 9:00 am - 11:00 am | 3:00 pm - 6:00 pm
Friday: Closed
Saturday: Closed
Sunday: Closed