New Patients

Your first visit

Typically, the first visit at Belcher Chiropractic consists of 3 pages of paperwork, a consultation, and exam.  If x-rays are necessary, we can conveniently take them in our office so Dr. Belcher can focus the x-rays on the area he is most concerned with.

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 either print the paperwork or fill out our intake paperwork online!! Once you're finished, hit submit & it comes right to us so we can prepare for your appointment ahead of time.

Then you can schedule here or call us for an appointment at (606) 676-0022!  

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

Chiropractor open now, back pain, chiropractic appointment, Somerset KY, online scheduling

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 and 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 recently.  We understand it may have been a problem for years but think about the most recent flare up.

if you prefer to download and print,  here's the PDF version of the paperwork.

For your convenience you can also 

click here to schedule an appointment

No phone call necessary and we are notified of scheduled appointments immediately!

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 designed for you to use to cover medical bills or lost wages after an auto accident without causing your monthly insurance premium to increase.

                     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. 

 Fill out our digital pediatric paperwork here.

If you chose to download & print the paperwork and want to go ahead and send it in, you can fax completed forms to (606) 676-0333 or email it to