Online Forms

Louisville Family Chiropractic offers our patient form(s) online so they can be completed it 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 (502-326-9952) your printed and completed form(s) or bring it with you to your appointment.
• If you are unable to print and complete the forms before your appointment time please arrive 15 minutes prior to your appointment time.

Application for Care-Required for all (unless pregnant)

Download & Print Form

Pregnant Application for Care-Required if Pregnant

Download & Print Form

 Patient Info Form - Required for all patients

 Terms of Acceptance Form - Required for all patients

 Auth, Assign, Consent to Treat Form - Required for all patients 

 HIPPA Privacy Policy Form - Required for all patients

Download & Print Form

Infant, Child & Adolescent Questionnaire- Required for all children

Download & Print Form

Personal Injury Form - Required for Motor Vehicle Accident

Download & Print Form