Patient Forms

We know that paperwork in a doctor’s office can be tedious and time-consuming to complete. But the information you provide helps give us an accurate picture of your current health and the conditions you are experiencing that need treatment.

Please use our list of forms to print and fill out our insurance coverage and patient health history forms.

In order to make your first visit to our office easier for you, please download all the forms and complete EACH of the forms at your convenience. Be sure to bring the completed forms with you to your first appointment, with any previous test results, x-rays, or health documents that you have and feel are important.

If for some reason you are not able to download these forms, please plan on coming in fifteen to twenty minutes prior to your scheduled appointment time to complete the paperwork in our clinic. In addition, please bring a recent copy of your health insurance card and a current photo ID if you plan to have our office bill your insurance company for your care.

New Patient Forms

Please print the forms, fill in and bring them with you.

New Patient Forms

HIPAA Statement

The forms are in the PDF format; in order to view them, you will need a PDF viewer such as Adobe Reader. If you do not have Adobe Reader you can click below to download it FREE.

 

Contact

Connell Chiropractic Clinic
20 Townlee Ln Suite C,
Lugoff, SC 29078, USA

T: (803) 408-9971

 
Morning
Afternoon
M
8:00 – 12:30
2:30 – 5:30
T
8:00 – 12:30
2:30 – 5:30
W
8:00 – 12:30
2:30 – 5:30
T
8:00 – 12:30
2:30 – 5:30
F
8:00 – 1:00