Your Health History

We offer our paperwork online so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.


Patient Information Agreement

  Download & Print Form


Car Accident Information

  Download & Print Form


Work Injury Information

  Download & Print Form


About Medicare Coverage

  Download & Print Form


Privacy Notice

  Download & Print Form


Terms of Acceptance

  Download & Print Form


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Each 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.

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Dr Scott Asks some important questions of interest to East Liverpool residents - Chiropractor East Liverpool Dr Scott Asks...

Will chiropractic adjustments make my spine too loose?
No. Only the spinal joints that are fixated and "locked up" receive attention. The occasional spinal joint that moves too much is passed over so weakened muscles and ligaments can strengthen and heal.
What's your plan to deal with drug-resistant 'super germs'?
Chiropractors have always been concerned with the indiscriminate use of antibiotics, accelerating the mutation of microbes that make "wonder" drugs increasingly ineffective. My strategy? Do everything possible to bolster my immune system through proper diet, rest, exercise, clean air, pure water and an optimally functioning nervous system with regular chiropractic care.