New Patients

Typically, the first visit consists of 3 pages of paperwork, a consultation, exam.  If x-rays are necessary, we will take them in our office so Dr. Belcher can focus the x-rays on the area he is most concerned with and you don't have to make an extra trip!

 

We understand that you are here in our office because you hurt, however the body is a complicated thing.  Dr. Belcher wants to make sure he gives you the best care possible.  After your initial visit is over, he sits down and examines your x-rays; taking measurements of angles, noting any irregularities, writing reports and so on. 

 

By doing so, he is developing his best care plan for you so we can tailor our chiropractic skills to suit your needs and condition.

 

If you are interested in taking a step towards better health, please call 606.676.0022 to schedule.   Or for your convenience, we've included a link at the bottom of the page that you can use to schedule.

 

We will accept Visa, Mastercard, personal checks and cash as well as most insurances, including Medicare and Medicaid.  We also see personal injuries and auto accidents.


Want a jump start on your first visit?  Below you'll find our new patient paperwork.  Click the icon, print the paperwork and fill it out!! Its all right at your fingertips!  


You can fax your paperwork to us at (606) 676-0333 or scan your documents and email them to NewPatient@BelcherChiro.com then schedule below or call us for an appointment!  

Check out our Contact Us tab for all our contact information!
























      • Page 1: 
        • This covers your basic information on the front page and your spouse or guardian information. 
      • Page 2:
        •  This is a form regarding your privacy.  The Health Insurance Portability and Accountability Act states you the patient need to clarify where we are allowed to contact you and who we may discuss your care with.  The left side of this page is where/how we may contact you and the right side of the page is like your own V.I.P. list.  Please list anyone who may call our office on your behalf to schedule, inquire about a balance, or ask questions about your treatment. 
        • This also gives you the option for an appointment reminder.  Please let our office know if you would like a phone call the business day before your appointment or if you'd like an auto generated email the day before your appointment.
      • Pages 3 & 4:
        • This is your typical health history information.  To make it easy, it is mostly check boxes however if you have had any surgeries, traumas like car accidents, 4-wheeler flips, tractor rolls, etc. you should list those and give the approximate dates.
      • Pages 5 & 6:
        • Lastly, this the Chief Complaint form.  There is room on this sheet for 3 areas of complaint.  The area that is bothering you the most goes on the front.  If you have additional areas, please use the back side. It is very important to narrow down how long an area has been troubling you. 


When you're done with paperwork, you can fax it to (606) 676-0333 or email it to newpatient@belcherchiro.com.  You can also click here to schedule an appointment!  No phone call necessary and we are notified of scheduled appointments immediately!

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