Online Forms

Lake Marion Chiropractic Center 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 form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Chiropractic Case History/Patient Information and Consultation Questionnaire Form # 1

Download & Print Patient History Form


Chiropractic Patient Update Form # 2

Download & Print Form


Lower Extremity Functional Scale Form # 3

Download & Print Form


DASH Reference Form # 4

Download & Print Form


General Pain_Index Questionnaire Form #5 GPI

Download & Print Form



Minnesota High School Sports Physical Forms #6

Download & Print Form


Patient Summary Form #7

Download & Print Form


Neck Index #8

Download & Print Form


Back Index #9

Download & Print Form

Locations

Find us on the map

Office Hours

Our Regular Schedule

Dr. Craig Couillard Hours

Monday:

7:30 am-6:45 pm

Tuesday:

9:00 am-2:00 pm

Wednesday:

7:30 am-6:45 pm

Thursday:

9:00 am-5:00 pm

Friday:

7:30 am-3:00 pm

Saturday:

Closed

Sunday:

Closed