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 he can tailor his 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 accept Visa, Mastercard, personal checks and cash as well as most insurances, including Medicare and Medicaid.  We also see personal injuries and auto accidents.   When we call, we use the very same sheet.


Want a jump start on your first visit?  Below you'll find our new patient paperwork.  Click the icon to get started!! 


You can now fill out our intake paperwork online!! Once you're finished, hit submit & it comes right to us.  
Then you can schedule below or call us for an appointment at (606) 676-0022!  
Check out our Contact Us tab for all our contact information!
Or if you prefer to download and print, here's the 2016 PDF version of the paperwork.





https://drive.google.com/open?id=1nZIxnVKpZ3Pz5u79pCqvOg4jbjKq-PdvtYFRp7Y7tDA&authuser=0


https://docs.google.com/forms/d/1iBs1iGqoWXcvEep4EI-_yvkbqLSHln5dUQ9BXtVSuZ4/edit?usp=sharing

















      • 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. 
      • 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  for 2 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. 





                                Children need chiropractic care, too! Have you ever thought about                           the trauma their bodies go through during pregnancy and the                                    birthing process?  It's natural but there can be many symptomatic                            issues that occur after birth. We have specifically designed                                      paperwork for children 5 years and younger.   
                                Click the picture to the left to fill out our digital pediatric paperwork.












          https://drive.google.com/file/d/0B729-M4zggFScHlKR0xNLW56MVE/view?usp=sharing

If you chose to download & print the paperwork, you can fax completed forms 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!