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402-721-6372 H
H

402-721-6372

Online Forms

Duncan Chiropractic Health Center, LLC offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Paperwork

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

https://intake.mychirotouch.com/?clinic=DCHC0008 - MUST be filled out online before initial visit.

Please print the following forms, fill out, and bring to your initial visit if applicable.

Health History Questionnaire

Revised Oswestry

Consent of Treatment

Notice of Financial Responsibility


Motor Vehicle Accident Patients

Auto Accident Questionnaire


Medicare Patients

Advance Beneficiary Notice

Activities of Daily Living


Medicaid Patients

Medicaid Coverage Form


Release of Records

Authorization for Release of Patient Health Records



Download the Free AdobeReader®

Mail Chimp

Office Hours

DayMorningEvening
Monday9:00 - 1:003:30 - 6:00
Tuesday9:00 - 1:003:30 - 6:00
Wednesday9:00 - 1:003:30 - 6:00
ThursdayClosed3:30 - 6:00
Friday9:00 - 1:00Closed
SaturdayClosedClosed
SundayClosedClosed
Day Morning Evening
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00 - 1:00 9:00 - 1:00 9:00 - 1:00 Closed 9:00 - 1:00 Closed Closed
3:30 - 6:00 3:30 - 6:00 3:30 - 6:00 3:30 - 6:00 Closed Closed Closed