Online Forms

Leger Chiro-Health and Wellness offers our patient form(s) online so you can complete it in the convenience of your own home or 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.

New Patient Information Forms - (*) starred forms are required

These forms will let us know your medical history and current state of your health.

Patient Personal Information Form* - Please have personal identification and health insurance card available when you come in for your appointment.

Patient Initial Evaluation Form* - This form covers current health condition, family and medical history. If you are currently taking any medication please make sure to note those medications in the appropriate area. If there is anything that the doctor should know that is not listed on the form, please make a note of it in the appropriate areas of the form.

Patient Initial Complaint Form* - This form will help you inform the doctor where you are experiencing pain or discomfort and list your complaints in order of severity. If you do NOT see your complaint on the picture, please list the complaint on the Other  line.

What questions, concerns, goals, regarding wellness can we help you with? Please let us know!