Online Paperwork

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.


Patient Information

This form covers the basic information that we need for you to begin care in our office. Please note this is a 5 page form.

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Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.




Dr. Ted Glazer | Phone: (610) 254-8200
418 E. Lancaster Avenue, Wayne, PA

Dr. Lori Kale | Phone: (610) 651-0234
91 Chestnut Rd., Paoli, PA

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Dr. Ted & Dr. Lori Asks some important questions of interest to Wayne and Paoli residents - Chiropractor Wayne and Paoli Dr. Ted & Dr. Lori Asks...

What's the difference between sick care and health care?
Sick care is largely about relieving or suppressing symptoms. Health care is about improving performance. While sick care is about how you feel, health care is about how you function. Sick care is what you do to treat an obvious problem, and health care is what you do to avoid the problem and advance your well-being.
What's a side effect?
It may sound like a bonus; something extra, but chiropractors know it should more accurately called an "unintended effect," and "unwanted effect" or in some cases an "adverse effect." A pill can't come close to matching your body's ability to create and deliver the essential compounds it needs. That's when it's important to make sure your nervous system is working correctly—the purpose of chiropractic care!