Campbellsburg Chiropractic offers our patient form(s) online so they can be completed 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 forms, print them out and fill in the required information.
- Fax us your printed and completed forms or bring it with you to your appointment.
Fax #s: Campbellsburg (502)532-0096 Bedford (502)221-8003 LaGrange (502)265-1214 Carrollton (502)662-0144
New & Returning Patients Forms
Fill out these documents from home to save time in office. Date paperwork for the date of your appointment. 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! The more information provided, the better we can serve you!
DOT Physicals / Medical Certificates
Fill out these documents to save time in office. Fill out neatly and completely. Date paperwork for the date of your appointment. Tips: bring a medications list that includes the dosage and frequency and be sure you are able to notate which medications is taken for which purpose/condition, bring your glasses if you wear them, avoid consuming foods with large quantities of sugars, salts, and caffeine the morning of your appointment, for best results.
Massage Therapy Forms
Fill out these documents to save time in office. Date paperwork for the date of your appointment. These documents do differ from chiropractic patient documents.
Please note: Massage therapy appointments are by appointment only. We do ask that you give more than a 24 hour notice if changing or cancelling your appointments. Appointments cancelled with less than a 24 hour notice are subject to a cancellation fee of half the value of the service scheduled for first time cancellations. Second time cancellations are subject to a cancellation fee for the full value of the service scheduled.
Notice of Privacy Practices
In this document, you will find details on our office Privacy Practices regarding Protected Health Information.