New Patient Forms

Online Patient Forms
The following forms have been made available to you in order to make your registration at our office faster and easier.

Overview of Different Forms

  • Forms 1-6 need to be completed by all new patients to our office.
  • Form 7 needs to be completed only if the patient has had an automobile accident that has caused the injury for which he/she is seeking care.

Download Forms
Click on the appropriate links to view and print your required forms. All forms are in PDF format.

  1. New Patient Form
  2. Pain Assessment
  3. Patient Health Information Consent
  4. Informed Consent to Chiropractic Treatment
  5. Patient Agreement Form
  6. Financial Policy
  7. Vehicle Accident Form

To view PDF files you will need to have Adobe Reader installed on your computer.
You can get Adobe Reader here.

 

Meet the Doctor

Dr. James M. Vander Yacht, D.C.

1980
Graduated from Blaine, Washington High School, Washington State.

1983
Completed undergraduate studies at Washington State University.

1986
Graduated from Palmer College of Chiropractic. Doctor of Chiropractic D.C. Degree.

1987-Present
Private practice in Salina Kansas.

Dr. Vander Yacht is a member of the American Chiropractic Association. He enjoys travel, golf, boating, target shooting, and collecting ancient Roman and Greek coins.

Map and Directions

Our Office is located at:
1333 W. Crawford St.
Salina, Kansas 67401


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