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Online Paperwork

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New Patient Form

This lets us know what’s happened, but perhaps more important, where do you want to take your health?

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Personal Injury/Workers’ Compensation

If your health issue is the result of either a work accident or a non-work related accident, we need some additional information.

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This is the standard Privacy Consent Form that is required by Federal HIPAA Law that needs to be completed. It is for use or disclosure of Private Health Information. Patient signature is required on both pages.

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Get adobe readerEach form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Merkel Chiropractic | (215) 368-7771

Helping families in Lansdale and surrounding areas with all of their chiropractic needs.