DR. CHANTEL SERACK, D.C.

 

Clinic Forms

 

Here are some forms you may need when visiting the clinic

 

New Chiropractic Patient Form - If you are a new chiropractic patient, PLEASE PRINT off the following form to complete. If you are not able to, we will have you fill in the form once you arrive in our office. We no longer require Provincial Health Numbers unless this appointment is related to a claim with SGI or WCB. We ask that all new patients arrive at least 10 minutes prior to their Initial appointment.  IF THE APPOINTMENT IS FOR A CHILD UNDER THE AGE OF 10 SEEING DR. CHANTEL SERACK SHE HAS SPECIFIC FORMS TO BE FILLED OUT THAT ARE NOT AVAILABLE ON OUR WEBSITE. 

DUE TO SYSTEM ERROR- THERE IS NO SUPPORT FOR ONLINE SUBMISSIONS OF THESE DOCUMENTS. 

Please Note: This form is designed to be printed double sided if your printer can support double sided printing. 

Update forms for Chiropractic care- this applies to anyone who has not been seen in our office for Chiropractic care for over one(1) year or more. - forms not available on our website. Please arrive 10 minutes early to complete these forms in the clinic.