Patient Forms - Yucha Medical Pain Management & Chiropractic Rehabilitation - Pottstown, PA
Medical Services
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Patient Forms

These documents allow our doctors to assess and understand your past and current health situation. The New Patient Intake Form seems lengthy, but most of the questions require only "YES" or "NO" answers. The information you provide is crucial in determining the best course of care. Please ask our Front Desk for assistance if required.

Once you’ve completed these forms, you will be escorted to the doctor’s office to begin your consultation. Following your consultation the doctor will perform a thorough chiropractic, orthopedic, physical and neurological exam. The purpose of this examination is to locate and establish the cause of your complaint so a treatment plan can be developed for your specific needs. When required, x-rays will be taken in our office to assess and diagnose your current condition. Having a complete x-ray facility on the premises enables your doctor to meet this need without referring you out of our office. These x-rays are then property of Yucha Medical Pain Management & Chiropractic Rehabilitation and may be released for short periods of time.

Authorization to Contact/HIPAA form and Automatic Appointment Reminder Consen

Motor Vehicle/Personal Injury Information form

Patient Health Record

Medical Pain Management and Chiropractor in the following areas: Pottstown, Limerick, Chester Springs, Boyertown, Gilbertsville and Royersford