New Patient Intake Forms

Thank you for choosing Lakeshore Family Chiropractic and Wellness. In order for us to offer the best care, we need you to complete the intake forms prior to coming in for your first appointment. We have multiple forms to offer the most specialized care for you. Please choose the form that best applies to the care you are seeking. If you have any questions surrounding which form to choose, please call us and we will guide you to the correct form. When you are finished, click submit and the forms will come right to us!

Adult New Patient Intake Form

Adolescent New Patient Intake Form

Infant/Child New Patient Intake Form

Pregnancy Intake Form

Focus Intake- Child 

Focus Intake- Adult

Current Patient Forms

Here are a few of our office forms for easy access. Choose the form you need, fill it out and click submit. It will come right to us.

Pregnancy Update Form

Postpartum Update Form

Authorization for the Release of Medical Records

Photo and Testimony Release Adult

Testimony Release Adult

Photo and Testimony Release Minor Child

Testimony Release Minor Child

Thank you!

Dr. Sara Young

Dr. Cathy Boufford