4107 Jefferson Hwy.  |  Jefferson, LA 70121

504-837-7722

Forms

Please print and fill out forms relevant to your procedure and bring with you to your appointment. Click on the icons below to access.

Allergy Therapeutics Form

Chiropractic Patient Information

Chiropractic Case History

Please adhere to the following guidelines:

•As a courtesy to our other patients who may have strong sensitivities, please do not smoke or wear perfume or fragrances prior to coming in to the clinic.

•Do not eat or chew gum during the session.

•The clinic has a 24-hour cancellation policy. Late cancellations or no-shows will incur a charge of $55.00.

•Please arrive 10 minutes prior to your appointment time. Late arrivals may be rescheduled and will incur a charge of $55.00.

•Payment is due at the time services are rendered.