Patient Paperwork to Save Time on Your First Visit

Complete and Bring to the Office or Send Electronically

New Patient Forms

We offer our patient forms online so the patient paperwork can be completed in the convenience of your own home or office.
  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • All new patients fill out: new patient intake, HIPAA consent, payment policy,  consent for treatment, and payment policy forms.
  • In addition, you will be asked to fill out an outcome assessment form for each area of symptoms. If you have any questions about the patient paperwork, feel free to contact the office via phone or e-mail.
New Patient Intake Form
HIPPA Consent Form
Consent for Treatment Form
Payment Policy
Start Back Screening Tool
Low Back: Revised Oswestry Index
Neck/Upper Back: Neck Disability Index
Arm/Shoulder/Hand: QuickDASH-9
Hip/Knee/Ankle/Foot: Lower Extremity Functional Scale

Contact Lederman Chiropractic & Sports Medicine

Wheaton Chamber of Commerce Member
American Chiropractic Association Member
Illinois Chiropractic Society Member
McAndrews Chiropractor Clinic proudly supports #WheatonProud

Office Hours

Mon: 8am – 11am and 2pm – 6pm
Tues: 8am – 11am and 2pm – 6pm
Wed: 2pm – 8pm
Thurs: 8am – 10am and 2pm – 7pm
Fri: 8am – 11am and 2pm – 5pm
Sat: Closed
Sun: Closed

Lederman Chiropractic & Sports Medicine

1275 Butterfield Rd Suite 110
Wheaton, IL 60189
(630) 510-0080

Google
LinkedIn
YouTube
Instagram
Yelp
Menu