Online Forms

Complete Health of Lawrenceville offers patient forms online so they can be completed in the convenience of your own home or office.  

Please follow the directions below to complete your New Patient Paperwork.

For your First Appointment, please bring:

  • Insurance Card(s)
  • Drivers License or other Photo ID
  • Any Applicable Imaging (X-rays, MRIs, CT Scans, etc.)
  • Any Applicable Testing (EMG, Nerve Conduction Test, etc.)

If you are unable to complete online paperwork prior to your appointment, please arrive at the office 20 minutes before your appointment time. 


For Motor Vehicle Accident Patients, please also bring: 

  • Auto Insurance Card
  • Declarations Page (Usually the first page of your policy stating your auto insurance benefits)
  • Any Claim Correspondence (Claim Number, Adjuster, and Adjuster's Contact Information)
  • Contact Information for your Attorney (if applicable)

If you are unable to complete online paperwork prior to your appointment, please arrive at the office 30 minutes before to your appointment time. 



REQUIRED PATIENT PAPERWORK: 

This paperwork is required for all New Patients as well as existing patients that have not visited the office within the last 2 years.  

Please click on the button(s) below to complete your New Patient paperwork.  Please submit all paperwork that is applicable to your appointment(s). 

INTAKE-FORMhipaa-covid-consent-financial-policy

chiro-consent

hipaa-policy


acupuncture-intake-and-consent


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***FOR ACUPUNCTURE PATIENTS: The acupuncturists need every new patient to email tongue pictures prior to your appointment.  Please take one photo of the top of your tongue, relaxed and out of your mouth.  Please take another photo of the underside of your tongue (as if you were licking the roof of your mouth).  Yes, these are an important part of the Acupuncture and Chinese Medicine evaluation.  Please email these photos, with your Patient Name in the Subject line, to [email protected] prior to your appointment.  




REQUIRED LIABILITY/ACCIDENT PAPERWORK: 

motor-vehicle-accident-forms

workers-compensation-forms

letter-of-protection-form

Neck Disability Index (if applicable)

Low Back Disability Questionnaire (if applicable)


***FOR MOTOR VEHICLE ACCIDENT PATIENTS: Please note that to successfully process your MVA claims, we will need you to bring a copy of your auto insurance card and declarations page. We will also need you to provide your medical adjuster's contact information. Please review your auto insurance policy to see whether your health insurance is elected as your primary insurance. 



RECORD REQUEST PAPERWORK:

medical-records-from-CHL

records-request-to-CHL

***FOR MEDICAL RECORDS REQUESTS: Please allow 1-2 weeks for any medical record request from Complete Health of Lawrenceville. If you need medical records by a certain date, please plan accordingly and add date to request.



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Updated 10/12/2021

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