New Patient Paperwork

Balderston Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.

New Patient Health History Form

Returning Patient Update Form

Motor Vehicle Collision/Auto Accident Form

Insurance Accepted

We file all insurances and are providers for those listed below and many others. Please contact our office to find out more. We would be glad to tell you which services in our office are covered by your insurance policy.

  • Aetna
  • Bankers
  • Blue Cross/Blue Shield
  • Central States
  • Cigna
  • Coresource
  • Coventry National
  • Employee Benefits
  • First Health
  • Golden Rule
  • Guardian
  • Hartford
  • Humana
  • Liberty Mutual
  • Medicare
  • Preferred Health
  • Principal
  • Prudential
  • Shelter
  • Travelers
  • UMR
  • United Healthcare
  • USAA

8:00am - 6:00pm

8:00am - 4:00pm

8:00am - 6:00pm

8:30am - 6:00pm

8:00am - 6:00pm


Balderston Chiropractic
6308 Monrovia Street
Shawnee, KS 66216
Phone: (913) 631-8888
Fax: (913) 962-1627