Advanced Chiropractic of Middletown Delaware offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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 to our office?
In this section you will find out what we need to help you become a new patient. Please click on the link below to download our new patient forms and fill them out prior to your initial examination as this can save time upon arrival.
If you are using your Major Medical Insurance or Medicare Insurance please bring the following:
- State Issued Photo ID
- Insurance Card
- Emergency Contact Information
- Previous Medical History (if available)
- List of Current Medications
- Name and Phone Number of your Primary Care Physician
Cash Rates Are Also Available
If this is an Auto Claim, Work Comp Claim or Personal Injury Claim in addition to those listed above, please bring the following:
- Any information pertaining to your injury. Including, but not limited to the date of accident/injury, police reports, hospital notes..
- Name and Number of the Insurance Company handling your claim
- Name and Number of the claim adjustor associated with your claim
- Name and Number of any attorney that may be representing you