New Patient Paperwork

Miller Chiropractic offers our patient form(s) online so they can be completed at the convenience of your own home or office. For your first visit, please also bring your driver's license and insurance card.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.

  • New Patient Intake Form

    Click to Complete

  • Electronic Health Records Intake Form

    Click to Download

  • Systems Survey Form

    Click to Download

OFFICE HOURS

Monday
8:30am - 6:00pm

Tuesday
8:30am - 12:00pm

Wednesday
8:30am - 6:00pm

Thursday
Closed

Friday
8:30am - 5:00pm

Saturday
Closed

Laura Lawlor, LMT
is Available By Appointment at
(563) 659–9956,
or at (563) 219–4160

Miller Chiropractic

107 East 11th Street
Dewitt, IA 52742

(563) 659-9956