WARNING

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

Close [x]

Gulotta Chiropractic Wellness Institute 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 Patient Health History Form - Required

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.

New Patient Intake Form

EHR Certification

HIPPA Form

X-ray Consent Form


Auto Accident form:

Motor Vehicle Collision Form

Auto Accident Questionnaire


Workman’s Comp:

Workman's Comp Intake

Workers Comp Form



Download the Free AdobeReader®

THIS ---->https://lakecomochiropractor.com/online-forms.html

Office Hours

DayMorningAfternoon
Monday9:00am - 12:00pm3:00pm - 6:00pm
Tuesday9:00am - 11:00amClosed
Wednesday9:00am - 12:00pm3:00pm - 7:00pm
ThursdayClosedClosed
Friday9:00am - 12:00pm3:00pm - 6:00pm
Saturday9:00am - 11:00amClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00am - 12:00pm 9:00am - 11:00am 9:00am - 12:00pm Closed 9:00am - 12:00pm 9:00am - 11:00am Closed
3:00pm - 6:00pm Closed 3:00pm - 7:00pm Closed 3:00pm - 6:00pm Closed Closed

Testimonial

Very clean practice with the latest technologies and a staff that is very friendly.

Kristen P
Lake Como, Lake Como, NJ

Newsletter Sign Up