Patient Forms
There are several forms we will ask you to complete during your first visit.
If you would like to arrive at our office with the forms already completed, please feel free to download them (PDF format), print them, and bring them to the office.
For Child Patients
(for children ages 0-4)
Child Patient Form (PDF)
Health Care Authorization Form (PDF)
Terms of Acceptance Form (PDF)
For Child Patients
(for children ages 5-17)
Patient Information Form (PDF)
Health Care Authorization Form (PDF)
Terms of Acceptance Form (PDF)
Consent for Treatment of Minor Form (PDF
For Auto Accident Patients
Automobile Accident Questionnaire (PDF)
Health Questionnaire (PDF)
Health Care Authorization Form (PDF)
Terms of Acceptance Form (PDF)
For Out-of-Town Chiropractic Patients
Patient Information Form (PDF)
Health Care Authorization Form (PDF)
Terms of Acceptance Form (PDF)
For All Other Patients
Patient Information Form (PDF)
Health Care Authorization Form (PDF)
Terms of Acceptance Form (PDF)
Offering quality chiropractic care to children and adults. The Initial consultation is always at no charge.
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Team Lopez Chiropractic is located in the Southwest Orlando suburb of Winter Garden, FL, in Stoneybrook West Village.
15497 Stoneybrook West Parkway
Winter Garden, FL
Learn what patients are saying about Team Lopez Chiropractic...
“I'm a huge fan of Dr. Nasly Lopez, impressed with her professionalism, patience and charisma, and I would recommend her services to everyone.”
Team Lopez Chiropractic
15497 Stoneybrook W. Pkwy
Suite 180
Winter Garden, FL 34787
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ph: (407) 654-9888
fx: (407) 654-9886
“Most insurances are accepted. Please call our office for your benefit details.”