New Patient Paperwork

Chiropractic Spine Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

All forms are PDF files. You will need AdobeReader® to view them.
If you do not already have AdobeReader® installed on your computer, Click Here to download.
Download the necessary form(s), print them out and fill in the required information.
Fax us your printed and completed form(s) or bring them with you to your appointment.

OFFICE HOURS

Monday
8:00am - 7:00pm

Tuesday
8:00am - 7:00pm

Wednesday
8:00am - 7:00pm

Thursday
8:00am - 7:00pm

Friday
8:00am - 7:00pm

Saturday
8:00am - 1:00pm

Chiropractic Spine Center
744 West Lancaster Avenue #105
Wayne, PA 19087
(610) 254-8200

"After years of competitive sports, I thought that my knee pain was something I should expect. I could not have guessed that working with Dr. Glazer to align my back and hips could correct old injuries. Injuries that I assumed were par for the course. I only wish I had come to see him ten years sooner.."

Simona

"Within an hour of his adjustment I’m 90% free of symptoms, then within 3 hours they are gone completely. It is nothing short of amazing. I will continue to recommend Dr. Glazer to everyone I know."

Ann

"Dr. Ted is simply the best Chiropractor on the Mainline. I went to his office because I fell and couldn’t walk without a lot of pain. After the first treatment, I felt so much better. Now, about 3 weeks later, I am pain-free. Dr. Ted is so caring, gentle, and knowledgeable about all kinds of injuries."

Susan