​
  • START HERE
    • First Visit
    • TEACHERS MONTH AT LIGHTSOURCE
    • MONTHLY SCHEDULE
    • FREE PHONE CONSULT
    • ABOUT OUR PRACTICE
    • OUR STATEMENT OF PURPOSE
    • MEET YOUR CHIROPRACTOR
    • BRAG PAGE
    • Gift Certificates
  • SCHEDULE / EVENTS
    • ESTABLISHED PATIENT SCHEDULING
    • BRING A FRIEND DAY
    • First Visit >
      • Adult First Visit >
        • ADULT HISTORY FORM
      • KIDS FIRST VISIT >
        • KIDS HISTORY FORM
      • BABY FIRST VISIT >
        • BABY HISTORY FORM
    • CHECK MY INSURANCE
    • RE EVALUATION
    • LUNCH & LEARN AT HOME
    • LUNCH & LEARN FOR YOUR GROUP
    • New Patient Workshop
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  • RESOURCES
    • THIS MONTH'S NEWSLETTER
    • YOUNG LIVING WEBSITE
    • Videos of our care
    • Can't Nurse?
    • CHIROHEALTH USA
    • WHO / WHAT WE LOVE >
      • GREAT STUFF / SERVICES
      • Q-DISC EMF
      • PROSPERITY COIN
    • AMAZING FAMILY MAGAZINE
    • BIRTHFIT
    • ARTICLES FOR EDUCATION >
      • GLUTEN / DAIRY FREE
      • MERRIC CHART
      • LYME TESTING
      • THE GEOMETRY OF THE SYSTEM
      • WHAT IS BGI
      • CHIRO FOR SAFER PREGNANCY
      • THE ONLY CONSTANT
      • THE CHIROPRACTIC OATH
      • MULTIPLE DIMENSIONS OF THE SPINE
      • COMMITMENT
      • ADHD CASE STUDY
      • EAR INFX
      • AUTISM PREVENTION
      • FOR ATHLETES
      • HEALTHY KIDS
      • THE VACCINE BUBBLE
      • C SECTION FACTS
      • MINDFUL MOTHERING
      • CHIROPRACTIC HONORS CHILD
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LIGHTSOURCE CHIROPRACTIC

Serving Clinton and Princeton with Gentle Family Care since 2001. 
CALL NOW

KIDS HISTORY FORM

LIGHTSOURCE CHIROPRACTIC IS PROUD TO SERVE GENTLE, WHOLE FAMILY CARE IN DOWNTOWN CLINTON AND PRINCETON.
​ENJOY BROWSING OUR SITE AND LET US KNOW IF YOU HAVE ANY QUESTIONS! OFFICE NUMBER: 908.238.1081

PLEASE START HERE BY SIGNING OUR HIPPA FORM! ​

    Please be as detailed as possible. The more information we have, the more we know how to help you! If you would rather print and bring your paper work in, CLICK HERE. 

    We will check your insurance for you. Please disregard if you have an HMO or no insurance. 



    For Parents: 




    Your child's health history: 

    Your child's first visit with us will include a thorough health history and detailed spinal exam. The more information we have to understand how stress is effecting your child, the more we will know how to serve them optimally. Please be thorough with this form, and we thank you in advance for your provocativeness with your child's wellness. 
Submit

​LIGHTSOURCE CHIROPRACTIC OF CLINTON     
6 East Main Street, Suite 6
​Clinton NJ 08809    ​908.238.1081

LIGHTSOURCE CHIROPRACTIC OF PRINCETON
360 Nassau Street, next to Whole Earth Center
Princeton, NJ 08540  609-924-6200

MAILING LIST
  • START HERE
    • First Visit
    • TEACHERS MONTH AT LIGHTSOURCE
    • MONTHLY SCHEDULE
    • FREE PHONE CONSULT
    • ABOUT OUR PRACTICE
    • OUR STATEMENT OF PURPOSE
    • MEET YOUR CHIROPRACTOR
    • BRAG PAGE
    • Gift Certificates
  • SCHEDULE / EVENTS
    • ESTABLISHED PATIENT SCHEDULING
    • BRING A FRIEND DAY
    • First Visit >
      • Adult First Visit >
        • ADULT HISTORY FORM
      • KIDS FIRST VISIT >
        • KIDS HISTORY FORM
      • BABY FIRST VISIT >
        • BABY HISTORY FORM
    • CHECK MY INSURANCE
    • RE EVALUATION
    • LUNCH & LEARN AT HOME
    • LUNCH & LEARN FOR YOUR GROUP
    • New Patient Workshop
    • EVENTS CALENDAR
  • RESOURCES
    • THIS MONTH'S NEWSLETTER
    • YOUNG LIVING WEBSITE
    • Videos of our care
    • Can't Nurse?
    • CHIROHEALTH USA
    • WHO / WHAT WE LOVE >
      • GREAT STUFF / SERVICES
      • Q-DISC EMF
      • PROSPERITY COIN
    • AMAZING FAMILY MAGAZINE
    • BIRTHFIT
    • ARTICLES FOR EDUCATION >
      • GLUTEN / DAIRY FREE
      • MERRIC CHART
      • LYME TESTING
      • THE GEOMETRY OF THE SYSTEM
      • WHAT IS BGI
      • CHIRO FOR SAFER PREGNANCY
      • THE ONLY CONSTANT
      • THE CHIROPRACTIC OATH
      • MULTIPLE DIMENSIONS OF THE SPINE
      • COMMITMENT
      • ADHD CASE STUDY
      • EAR INFX
      • AUTISM PREVENTION
      • FOR ATHLETES
      • HEALTHY KIDS
      • THE VACCINE BUBBLE
      • C SECTION FACTS
      • MINDFUL MOTHERING
      • CHIROPRACTIC HONORS CHILD
  • CONTACT & LOCATIONS
    • FIND US!
    • MEET OUR TEAM
    • Review us online!
    • JOIN OUR TEAM
  • FACEBOOK
  • FAQ
  • Letters From Santa