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Online Forms

Lane Chiropractic & Wellness 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 your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

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!

#New Patient Form

Laser Assisted Weight Loss Program Comprehensive Intake Questionnaire Form

This form is the initial quiestionnaire for patients interested in the Well Weight Loss Program. For more information, click on the Well Nutrition & Health Services tab or call us 570-836-2751!

Laser Assisted Weight Loss Intake Questionaire

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