New Patient

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Welcome!

Dr. Jay Leidy would like to welcome you to your new home for health and wellness! Our goal here is to provide outstanding care to our patients. We aim to help every patient achieve a fruitful and happy lifestyle full of the activities they enjoy the most. We recognize that each patient is a whole person and helping them reach true health and wellness is a collaborative effort between our professional and our patients. We look forward to helping you achieve the health and wellness you desire!

When you schedule your New Patient Appointment you will be seen by our dedicated practitioner, Dr. Jay Leidy. He utilizes various modalities to determine the bodies sensitivities and provide the necessary tools to bring balance back to the body!

New Patient Initial Exam– Our doctor performs a physical exam which includes checking over 200 organs, glands, infections, and tons more! This will locate imbalances in the body so that Dr. Leidy can design a nutrition protocol to assist your body back to a state of balance.

Pricing:

New Patient Initial Exam – $355

New Patient Child Exam – $175

Follow up Visits (Adult) – $175

Follow up Visits (Child) – $95

Chiropractic ONLY – $95

Click Below To Download New Patient Paperwork!

New-Patient-Paperwork-Leidy-Holistic-Healthcare

Download

NEW PATIENT HEALTH HISTORY FORM

In order to provide you the best possible care, please complete this form and bring it to your first appointment or email it to
info@yourholistichealthcare.life. All information is strictly CONFIDENTIAL









    Medical History




    Family History

    Have you ever:









    Habits













    Signatures

    I understand that the office of Dr. Jay Leidy does not file insurance claims. 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 and are due at time of service.

    Have you ever suffered from any of the following?

    Please use the following letters to indicate TYPE and
    LOCATION of the symptoms you currently are
    experiencing.

    A= Acne O = Other
    B=Burning P=Pins & Needles
    N=Numbness S=Stabbing
    © Copyright 2005 ChiroMatrix
    frm Image

    Leidy Chiropractic, LLC

    1595 Skylyn Drive – Unit B

    Spartanburg, SC 29307

    AUTHORIZATION FOR EXAMINATION, REMEDY AND PAYMENT



    I understand that Dr. Jay Leidy may suggest a program of nutritional supplementation as part of the healing process. Analysis of body imbalances are based on muscle testing. It in no way enters into diagnosis of diseases or conditions. These findings only imply that the condition named is an imbalance and not a pathological disease process. Copyright 1990 by Theodore A. Baroody





    ASSIGNMENT AND AUTHORIZATION

    TO: Your Holistic Healthcare / Leidy Chiropractic
    1595 Skylyn Drive, Unit B
    Spartanburg, SC 29307

    In consideration of your undertaking to evaluate me, I agree to the following:

    1. I hereby attest to the accuracy of my medical and/or accident history and further certify thatI present myself to Dr. Jay Leidy for evaluation and/or remedy of a health-related condition and for no other purpose. I clearly understand that I am totally responsible for payment.

    2. I understand that the Office of Dr. Jay Leidy does not file insurance claims. 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 and are due at time of service.

    Your Holistic Healthcare, LLC

    1595 Skylyn Drive, UNIT B
    SPARTANBURG, SC 29307

    PRIVACY PRACTICES ~ ACKNOWLEDGEMENT OF PATIENT RECEIPT

    I have received or reviewed the private practice note (3 pages) for Your Holistic Healthcare LLC., and understand the situations in which this practice may need to utilize or release my medical records. I also understand that I agreed to the use of those records when I initially applied for care at this office on my first visit, whenever that may have occurred.

    I understand that this office will properly maintain my records, and will use all due means to protect my privacy as outlined in this privacy practices statement.

        LEIDY HOLISTIC HEALTHCARE, LLC

        1595 Skylyn Drive, UNIT B
        SPARTANBURG, SC 29307

        PRIVACY PRACTICES ~ ACKNOWLEDGEMENT OF PATIENT RECEIPT

        I have received or reviewed the private practice note (3 pages) for Leidy Holistic Healthcare LLC., and understand the situations in which this practice may need to utilize or release my medical records. I also understand that I agreed to the use of those records when I initially applied for care at this office on my first visit, whenever that may have occurred. I understand that this office will properly maintain my records, and will use all due means to protect my privacy as outlined in this privacy practices statement.