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Patient Forms

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 AdobeReaderĀ® 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!

Download and Print


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!

Download and Print


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!                                                                                                          

Download and Print


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!

Download and Print  


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.

Download to review


New patients receive a consultation at no charge

Sign-up using the form or call us at 573-760-1515 to take advantage of this exclusive offer!

Our Location

307E Karsch Blvd | Farmington, Missouri, 63640

Office Hours

We Offer Evening Hours!

Monday:

10:00 am-12:00 pm

2:00 pm-8:00 pm

Tuesday:

10:00 am-12:00 pm

1:00 pm-8:00 pm

Wednesday:

10:00 am-12:00 pm

1:00 pm-8:00 pm

Thursday:

10:00 am-12:00 pm

1:00 pm-8:00 pm

Friday:

10:00 am-12:00 pm

1:00 pm-8:00 pm

Saturday:

Closed

Sunday:

Closed