Gindele Family Chiropractic, Fort Myers - Neck Pain, Back Pain, Auto Accidents, Wellness
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    • Dr. Nathan C. Gindele, Chiropractor
    • Dr. Brie Gindele, Chiropractor
    • Tonia Z, Reception/Insurance
    • Valeri W., LMT
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WELCOME to our office. We are happy you made the choice to make our office your Wellness Headquarters. We look forward to serving you.

Find out more about Chiropractic by clicking HERE.


New Patient Paperwork
If you would like to save yourself time at your first appointment, please print and fill out the paperwork and bring it with you to your first appointment.  Please be sure to fill out the New Patient Intake as completely as possible. If you have any questions in regards to the paperwork, please let us know at your appointment.  Thank you.

NOTE!! 
All paperwork is password protected so please choose
"Read Only" to print.

General Paperwork -

new_patient_intake_history.doc
File Size: 90 kb
File Type: doc
Download File

INFORMED CONSENT FORMS
File Size: 34 kb
File Type: doc
Download File

OPEN ADJUSTING CONSENT
File Size: 65 kb
File Type: doc
Download File

Insurance Forms

CLAIM FORM SIGN-OFF
File Size: 1648 kb
File Type: jpg
Download File

Medicare Specific Forms

MEDICARE ABN FORM
File Size: 58 kb
File Type: doc
Download File

MEDICARE CHIROPRACTIC POLICY
File Size: 63 kb
File Type: doc
Download File

VERTEBRAL SUBLUXATION COMPLEX

vsc.pdf
File Size: 1821 kb
File Type: pdf
Download File

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