Please click on the links below to download the forms, fill them out and bring them to your first appointment. Filling the forms out in advance will save you about 15 minutes. Thanks!

Adults New Patient Form

(ages 13 and older):

Children New Patient Form

(for children age 0-12, please print and fill out the following forms):


If you have been injured on the job or in an automobile accident, please fill out the following forms:


Your health is our concern. Our goal is to provide quality care at a fair and reasonable rate so that everyone can afford to take care of their healthcare needs. We accept auto accident, personal injury and all health insurance plans, including Medicare and Medicaid. Our staff will be happy to verify and explain your benefits before treatment.

Horak Chiropractic & Acupuncture believes in the value of wellness care for you and your family and have maintained a pricing structure that allows care for all budgets. For patients who have little or no chiropractic insurance coverage, flexible payment programs can be arranged. To learn more about our payment options for chiropractic and wellness care, please contact us.

 If you have any questions, please call us at (402) 904-7179. Thanks!


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