If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site


You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Follow Us

Lott Chiropractic Clinic, P.C. offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

New Patient Intake Form
Please complete this form prior to your appointment. This lets us know the history and current state of your health, as well as the reason for your visit with us.  

New Patient Privacy Form
Please read over this sheet, as well as list any relatives or friends whom you would like to be able to access your Protected Health Information. Once complete, please print and sign your name at the bottom. By signing this form, you  are attesting that you have reviewed our complete HIPAA Privacy Policy (link below).

HIPAA Privacy Policy (Updated 10/21/2017)
Please read this Policy, and sign the "New Patient Privacy Form" (link above). There is no need to print this document, unless you would like to retain it for your records.