Jasper, Indiana

✓

New Patient? Please click the link. Established Patient? Please use the links at the recommended interval.

New Patients

Scheduling

Check IN (Each Visit)

~

2024 Financial and Treatment Consent Form (Once per year)

2024 Medicare ABN Form (Once/Year)

2024 Acupuncture Consent Form (Once/Year)

High School Athletes

○

2024 Athlete Consent Form

👕

Prior to your appointment, please be sure to change into the appropriate apparel for your specific region of complaint(s).

Appropriate apparel
- T-shirt for Upper Extremity, Neck, and Upper Back Complaints
- Shorts and Bare Feet for Lower Back and Lower Extremity Complaints.
Restrooms are available for changing.

Outcome Assessment Tools

To track progress and to satisfy insurance guidelines, please complete the applicable form(s) below related to your primary and/or secondary complaint at your first visit of the month. Compliance may affect insurance coverage.

△

NECK AND UPPER BACK (Once/month)

Mid to Low Back and Pelvis (once/month)

Upper Extremity (once/month)

Lower Extremity (once/month)

Are you happy with how you are being treated? Let others in Jasper know.

Also consider leaving a review on Google. Not happy with how you are being treated? Leave some feedback. Constructive criticism is how we grow and improve!

⋆⋆⋆⋆⋆

Jasper Review

Give Feedback

Not happy with how you are being treated? Let us know.

Constructive criticism is how we grow and improve.

Contact Us

Active Chiropractic and Rehabilitation

209 3rd Avenue, Jasper, Indiana 47546, United States

812-301-2088.

Hours

Today

By Appointment

Home
Scheduling
New Patients
Patient Portal
Jasper
Bloomington
About
Covid-19 Policy
High School Athletes
Check-In
Outcome Assessment
Review

Happy New Year! Please take a moment prior to checking in to complete the appropriate forms for 2025. All patients need to complete the 2025 Financial and Consent Form.

Medicare folks please also complete the 2025 ABN and select "Option 2". Thanks for your help keeping your record current.

2025 Forms