Smith Chiropractic - Chiropractor In Lansing, KS USA

If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Home > New Patient Center > Online Forms

Smith Chiropractic 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.

Exclusive Offer

Featured Services

Services: We strive to provide complete care for our patients. Learn more about all the services we provide.

Make An Appointment: We will do our best to accommodate your busy schedule. Schedule an appointment today!

Online Forms: Our patient forms are available online so they can be completed in the convenience of your own home or office.

Testimonial

We value our patients' experience at Smith Chiropractic. If you are currently a patient, please feel free to complete the following Client Experience Questionnaire. The Questionnaire is in Adobe Acrobat format, and requires the free Acrobat Reader to view.
Download & Print Questionnaire

Dr. Ryan Smith

Lansing, KS

A. Application for Care-History (Day-1) (6)

B. ADL-Symptom-Medications (Day-1) (4)

C. QVAS

D. Informed Consent (Day-1) (4)

E. Notice of Privacy Practice (Day-1) (4)

F. Simple Release - HIPAA Release of Information (5)

Intermediate Application for Care (4)

Pediatric History (Day 1)