New Patient Forms

Recovery ChiroMed provides our forms online so that you can fill them out in the comfort of your own home and at your convenience. You can either complete and submit the form on our website, or you can download the fill-able PDF to complete and bring with you to our hospital.

If you would like to download the PDF, and do not already have AdobeReader® installed on your computer, click below to download for free.

Luling Forms

Kenner Forms

Lafayette, Opelousas and New Iberia Forms

Five Convenient Locations to Serve You

Lafayette

207 Rue Louis XIV
Lafayette, LA 70508

(337) 988-2188

New Iberia

603A Center St.
New Iberia, LA 70560

(337) 376-6153

Opelousas

619 E Vine St.
Opelousas, LA 70570

(337) 948-1800

Luling

12501 US-90
Luling, LA 70070

(985) 331-8007

Kenner

1301 W Esplanade Ave.
Kenner, LA 70065

(504) 461-2222