At this time, Long Chiropractic, Inc offers a convenient method for the public to print off online form(s) and fill them out at their leisure in their home or at the office prior to their scheduled appointment.
- 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 as completely as possible.
- Fax us your completed online form(s) to (573) 760-0817 or bring the form(s) with you to your appointment.
New Patient Intake Information form - Required
Click on the link below for the form that 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!
New "Pediatric" Patient Intake Information form - Required
Click on the link below for the form that lets us know the history and current state of your child's health. What questions, concerns, goals regarding wellness can we help you with? Let us know!
New "Personal Injury" Patient Intake Information form - Required
Click on the link below for the form that lets us know the history and current state of you health in regards to your personal injury. What questions, concerns, goals regarding wellness can we help you with? Let us know!
New "Worker's Compensation" Patient Intake Information form - Required
Click on the link below for the form that lets us know the history and current state of you health in regards to your worker's compensation injury. What questions, concerns, goals regarding wellness can we help you with? Let us know!
HIPAA Notice of Privacy Practices - Optional
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.