Skocik Chiropractic offers our patient form(s) online so they can be completed at the convenience of your home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download. Download the Free AdobeReader®
- You have the option to complete the forms online or download the necessary form(s), print it out, and fill in the required information.
- Fax or email us your printed and completed form(s) or bring it with you to your appointment.
Phone: (717) 540-8448
Fax: 717-540-6233
Email: [email protected]
New Patient Form - Required
Complete Online
Once you click submit, the form will be sent directly to our computer system. On your first appointment to the office, you will still have to sign a HIPAA form, Office Policy and complete any required insurance forms.
Download & Print Form
Please print then complete forms, once completed please fax, email or bring it with you to your appointment. On your first appointment to the office, you will still have to sign a HIPAA form, Office Policy and complete any required insurance forms.
Auto Accident Questionnaire - Only fill out if experiencing auto accident injury.
Download & Print Form
Work-Related Injury Questionnaire - Only fill out if experiencing work related injury.
Download & Print Form
What to bring to your new patient appointment
-Identification Card: The card must include your name, date of birth and a photo.
-Insurance Card if applicable. We treat many patients on a self-pay basis.
-Worker's Comp Claim Information: The information must include Insurance Carrier Name, Date of Accident, Employer's Name, Claim #, Insurance Carrier Phone #.
-Auto Claim Information: The information must include Insurance Carrier Name, Date of Accident, Claim #, Insurance Carrier Phone #. PA is a no-fault state, please bring your insurance carriers claim information no matter who was fault.
-Medication List: We can make a copy.
-Emergency Contact Information
*The new patient appointment will take approximately 1.5 hours, please make sure to have time in your schedule to complete the visit.