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.

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 2019 PDF version of the paperwork.

For your convenience you can also 
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No phone call necessary and we are notified of scheduled appointments

An auto accident at any speed can alter your spine and chiropractic care is usually covered through your auto insurance!  Kentucky is a classified as no-fault state which pertains to your medical bills and NOT whose fault the accident was.  With this, we file to your personal auto insurance and use the PIP policy that is written in to your auto insurance.  PIP stands for personal injury protection and is specifically for you to use to cover medical bills or lost wages after an auto accident without causing your monthly insurance premium to increase

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. If you have a list of medications, just bring it an we will copy it!

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.