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Practice Name

Lefkowitz Chiropractic

Primary Location
153 Fort Lee Road
Teaneck, NJ 07666
Phone: (201) 530-1000

Office Hours

DayMorningAfternoon
Monday10:00 am7:00 pm
Tuesday4:00pm8:00 pm
Wednesday10:00 am7:00 pm
Thursday10:00 am7:00 pm
Friday10:00 am3:00 pm
SaturdayBy Appt.By Appt.
Sunday
Main Content

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

Exclusive Offer

Exclusive Offer, New Patients receive Free Consultation. Usually $125.00 value

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Featured Services

Services We strive to provide complete care for our patients. Learn more about all the services we provide. Make An Appointment We will do our best to accommodate your busy schedule. Schedule an appointment today! Online Forms Our patient forms are available online so they can be completed in the convenience of your own home or office.

Office Hours

DayMorningAfternoon
Monday10:00 am7:00 pm
Tuesday4:00pm8:00 pm
Wednesday10:00 am7:00 pm
Thursday10:00 am7:00 pm
Friday10:00 am3:00 pm
SaturdayBy Appt.By Appt.
Sunday

Meet the Doctor

Meet Dr. Lefkowitz Dr. Lefkowitz honored 2013 Physician/Healer of the Year by Teaneck Chamber of Commerce!
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