Patient Forms

Thank you for showing an interest in becoming a practice member of our office and bringing your family's health to the next level.  The commitment of being a chiropractic patient starts with a complete case history form for one of our doctors to review.  While chiropractic is not about treating diseases, pain or conditions, we do need to know all about your past health history and any concerns you may have at the present time.  This information will direct the doctor in the proper care of you and your family so that we may obtain the best results in the shortest period of time.  If you need to add additional information, feel free to include a separate sheet with these three forms.  When scheduling a visit for a child (newborn to age 17), include information about the mothers’ prenatal care, pregnancy information (medications, ultrasounds, injuries, vaccines received, vitamins, health habits) as well as the birth process, complications, APGAR score and so forth.  Please mail or drop off these forms before your visit so they can be reviewed.  Also, if you  have had  any recent (within the past 6 months) X-Rays, MRI Scans or CAT Scans of your spine, it is of great importance that these are brought to our office with the reports at least three days before your scheduled examination.  All of this detail is absolutely necessary for us to be able to assist you to the best of our ability.  Thanks again for considering us and we look forward to meeting you and your family!                                                                                                                                                                                                                                                                                                                                                                                        Download and print the forms in Adobe format.  If you do not have the Adobe Reader, Click HERE to download it for FREE.   If you prefer, you may call our office (315-724-0368) and we will be happy to mail them to you or stop by to pick them up in person.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Click HERE to download the New Patient Paperwork.  Please be as complete as possible and write neatly. Thank you for your cooperation.  If you are completing this for your child, please complete all the paperwork below if age Birth to age 2 only.  Age 2 or older, complete the New Patient Paperwork and the mutual consent to treat a minor form by Clicking Here.  If both parents / guardians do not agree to care, we cannot see your child.  

Click HERE to download the SoftWave Pre-Screening Questionnaire if you are coming in for SoftWave Therapy.  (You must also download and fill out the New Patient Paperwork in the above link).  Note that answering any of these questions YES does not mean that you are not a candidate for SoftWave Therapy.

Click HERE to download the Neuropathy Questionnaire if you are coming in for Spinal Related Neuropathy SoftWave Treatment.  

Click HERE to download the Pediatric History Forms (ages Birth to 2).  If both parents / guardians do not agree to care, we cannot see your child.  

Click HERE to download the Auto Accident Questionnaire.  Please fill this out in addition to the New Patient Paperwork.


Return all of these completed forms to our office.  Once they are reviewed, you will be contacted for an appointment.

If you have any questions, please do not hesitate to contact us.  We look forward to caring for you and your family!

patient and doctor

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Location

LaBarbera Family Chiropractic LLC SoftWave Therapy

2719 Genesee Street

Utica, NY 13501 USA

(315) 724-0368

(315) 724-0374

Monday:

8:00 am - 5:30 pm

Tuesday:

8:00 am - 4:30 pm

Wednesday:

10:00 am - 5:30 pm

Thursday:

8:00 am - 5:30 pm

Friday:

9:00 am - 12:00 pm

Saturday:

Closed

Sunday:

Closed

We are open Friday, May 10, 17 and 31, 2024.