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Online Forms

Estadt Lemire Chiropractic Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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 Registration Packet - Required




New Patient Packet

Download & Print Form


Patient Update Packet

Download & Print Form


Lower Extremity

Download & Print Form


Upper Extremity

Download & Print Form


Medicare ABN Form

Download & Print Form


Personal Injury Form

Download & Print Form


Patient Registration Minor

Download & Print Form



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Locations

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Office Hours

Our Regular Schedule

Mentor Office

Monday:

8:00 am-6:00 pm

Tuesday:

8:00 am-6:00 pm

Wednesday:

8:00 am-6:00 pm

Thursday:

8:00 am-6:00 pm

Friday:

8:00 am-6:00 pm

Saturday:

8:30 am-11:00 am

Sunday:

Closed