Wagner Chiropractic
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    412-531-8701

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Patient Forms

Home > Patient Forms

Wagner Chiropractic is happy to offer our patients two options when filling out your paperwork on-line. You can download a printable PDF version by clicking the link below or click on the image to fill out the paper work on-line.

Download Form Here

Download the PDF version by clicking the link below

  • Entrance Form
  • Tobacco & Alcohol Form
  • Office Policy
  • Healthcare Authorization Form
  • Acknowledgement of Receipt of Notice of Privacy Practices

Contact Info

421 Cochran Rd. Pittsburgh, PA 15228

Get directions

Phone: 412-531-8701

info@wagnerchiropracticmtlebanon.com

Hours of Operation

Mon: 9am - 1pm & 3pm - 6:00pm
Tue: 3pm - 6:00pm
Wed: 9am - 1pm & 3pm - 6:00pm
Thurs: 3pm - 6:00pm
Fri: Closed
Sat: Appointment Only

Insurance We Accept

Highmark BC/BS, UPMC, UPMC for Life, UPMC for You, Aetna, United Health Care, Health America, Health Assurance, Cigna, Med Plus/UNISON, Gateway, Medicare

*If you do not see your insurance listed, please call to inquire regarding acceptance.

*We accept Visa/MC/AM EXP/ Discover
Wagner Chiropractic

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