Skip to content
Chiropractor White Plains NY
Menu
  • About
    • Meet Dr. Sirota
    • Dr. Sirota’s Inspiration
  • Services
    • Foot Levelers Custom Orthotics
      • SKIP THE CHEAP FLIP-FLOPS
      • 3D-Body Posture Scans
      • ORTHOTIC SHOE INSERTS
    • AUTO Accidents-No-Fault Doctor
    • NECK
    • BACK
      • HIP-FLEXOR ISSUES & LOW BACK PAIN
      • BAD POSTURE
    • SPORTS INJURIES
      • SHOULDER
      • KNEE
      • FOOT & ANKLE
    • BEMER-PEMT
    • ARPWave NeuroTherapy
  • Appointments
  • Reviews
    • Patients’ Reviews
    • Leave a Review
  • Blog
  • Forms
  • Resources
    • FAQs
    • Functional Neurology
    • Hiatal Hernia and Acid Reflux …RELIEF!
    • Video Library
    • Supplements
    • Stretching
    • Covid Safety Protocol
  • Contact

Treatment Cancellation Form

Treatment Cancellation Form

Posted on January 17, 2021January 2, 2023 by Jonathan Sirota


  • Version
  • Download 30
  • File Size 131.65 KB
  • File Count 1
  • Create Date January 17, 2021
  • Last Updated January 2, 2023
Download
Description

What people are saying:

Joel Savit

As professional and compassionate as you can ask for. The doctor takes pride in his work. I was treated with caring and experience. Dr. Sirota is a real gentleman and did everything in his power to relieve my pain. He also recommended supplements to decrease the pain I was having in my knees and my knees feel 100% better. I would highly recommend to anyone I know.

Joel Savit

Chiropractor White Plains NY
5
2017-07-19T09:47:30+00:00

Joel Savit

As professional and compassionate as you can ask for. The doctor takes pride in his work. I was treated with caring and experience. Dr. Sirota is a real gentleman and did everything in his power to relieve my pain. He also recommended supplements to decrease the pain I was having in my knees and my knees feel 100% better. I would highly recommend to anyone I know.
https://www.drsirota.com/testimonials/joel-savit/

Maricelly Velez-Delgado

The office is easy to find and has a great storefront. Office atmoshere is great!

Maricelly Velez-Delgado

Chiropractor White Plains NY
5
2017-07-19T09:56:22+00:00

Maricelly Velez-Delgado

The office is easy to find and has a great storefront. Office atmoshere is great!
https://www.drsirota.com/testimonials/maricelly-velez-delgado/

Jeffrey Ferraro

Dr. Sirota has magic hands. He always takes extra time to understand the root of a pain issue and then recommends the appropriate course of action to remedy it. He is an incredible healer. I see Dr. Jon on a regular basis to keep my body in tune. He is an exceptional chiropractor and wellness doctor. I would highly recommend him to anyone who has pain or chronic issues. Where other chiropractors have failed, Dr. Sirota has had success.

Jeffrey Ferraro

Chiropractor White Plains NY
5
2017-07-19T09:55:51+00:00

Jeffrey Ferraro

Dr. Sirota has magic hands. He always takes extra time to understand the root of a pain issue and then recommends the appropriate course of action to remedy it. He is an incredible healer. I see Dr. Jon on a regular basis to keep my body in tune. He is an exceptional chiropractor and wellness doctor. I would highly recommend him to anyone who has pain or chronic issues. Where other chiropractors have failed, Dr. Sirota has had success.
https://www.drsirota.com/testimonials/jeffrey-ferraro/

Matthew Rose

It's satisfying to find someone you can trust these days and Jon is that and more. Friendly, knowledgeable, and understanding - Jon has been a huge help to my back pain and helping my overall health. His new facility is polished and convenient and as my first and only chiropractor, I would recommend him to all

Matthew Rose

Chiropractor White Plains NY
5
2017-07-19T09:55:19+00:00

Matthew Rose

It's satisfying to find someone you can trust these days and Jon is that and more. Friendly, knowledgeable, and understanding - Jon has been a huge help to my back pain and helping my overall health. His new facility is polished and convenient and as my first and only chiropractor, I would recommend him to all
https://www.drsirota.com/testimonials/matthew-rose/

James Martyniak

Always a pleasure. Great bedside mannor. And really cares about fixing the issue. Wouldn't go anywhere else.

James Martyniak

Chiropractor White Plains NY
5
2017-07-19T09:54:23+00:00

James Martyniak

Always a pleasure. Great bedside mannor. And really cares about fixing the issue. Wouldn't go anywhere else.
https://www.drsirota.com/testimonials/james-martyniak-2/

Tucker White

Dr. Sirota is a miracle worker! I have had chronic lower back pain and knee and heel pain for years but never thought they were connected. But Dr. Sirota showed me that my lower back pain was caused by my bad posture from my sore knees and feet. After scanning my feet Dr. Sirota prescribed me a pair of triple arch orthotic inserts for my shoes to help support my arches and after a week my pain was almost gone! Taking advantage of his offer on groupon.com I received three re-alignments on three visits over the course of three weeks for only $90 and my back AND knee and arch pain are all gone! I used to wake up every morning with a sore back and think it was because of my mattress, I would never have guessed that it was because of poor posture caused by my arches. I've been to a few other chiropractors before but none of them did anything but give me an alignment. Dr. Sirota explained to me every detail of my situation not only in person but also in his chiropractically speaking videos on his website drsirota.com which honestly is the reason I felt...

Tucker White

Chiropractor White Plains NY
5
2017-07-19T09:53:42+00:00

Tucker White

Dr. Sirota is a miracle worker! I have had chronic lower back pain and knee and heel pain for years but never thought they were connected. But Dr. Sirota showed me that my lower back pain was caused by my bad posture from my sore knees and feet. After scanning my feet Dr. Sirota prescribed me a pair of triple arch orthotic inserts for my shoes to help support my arches and after a week my pain was almost gone! Taking advantage of his offer on groupon.com I received three re-alignments on three visits over the course of three weeks for only $90 and my back AND knee and arch pain are all gone! I used to wake up every morning with a sore back and think it was because of my mattress, I would never have guessed that it was because of poor posture caused by my arches. I've been to a few other chiropractors before but none of them did anything but give me an alignment. Dr. Sirota explained to me every detail of my situation not only in person but also in his chiropractically speaking videos on his website drsirota.com which honestly is the reason I felt confident in choosing Dr. Sirota in the first place. I'm a 21year old rugby playing senior in college and I felt that I was too young to be having pain like this already. The orthotic inserts that Dr. Sirota prescribed me fit right into my cleats so I can wear them in games and they fit in my boots so I can wear them at work. I plan on getting another alignment or two before I go back to school this fall because with every treatment I feel like I'm standing taller and straighter thanks to Dr. Sirota.
https://www.drsirota.com/testimonials/tucker-white/

June Grossman

My husband & I have been using Sirota Chiropractic for at least 5 years now. We ALWAYS feel that we are in good hands when we go there for an adjustment. In fact, since we began seeing Dr. Jon, we moved about an hour away, & still wouldn't even think about using anyone else. We will gladly travel to see him! Dr. Jon really cares about his patients. I, personally, always feel that Dr. Jon makes sure I get the treatment I need for that appointment. It's not always the same treatment & sometimes I need a little more therapy before the adjustment. I never feel like, while I'm there, he's "on the clock", trying to get done quickly because he has anotherpatient behind me. He REALLY cares & it's obvious he LOVES his work. I highly recommend Sirota Chiropractic for anyone looking for a great, result-oriented chiropractor!

June Grossman

Chiropractor White Plains NY
5
2017-07-19T09:53:01+00:00

June Grossman

My husband & I have been using Sirota Chiropractic for at least 5 years now. We ALWAYS feel that we are in good hands when we go there for an adjustment. In fact, since we began seeing Dr. Jon, we moved about an hour away, & still wouldn't even think about using anyone else. We will gladly travel to see him! Dr. Jon really cares about his patients. I, personally, always feel that Dr. Jon makes sure I get the treatment I need for that appointment. It's not always the same treatment & sometimes I need a little more therapy before the adjustment. I never feel like, while I'm there, he's "on the clock", trying to get done quickly because he has anotherpatient behind me. He REALLY cares & it's obvious he LOVES his work. I highly recommend Sirota Chiropractic for anyone looking for a great, result-oriented chiropractor!
https://www.drsirota.com/testimonials/june-grossman/

Anon

Awesome! Took my No fault auto accident insurance when no one else would. Unbelievable result in 3 visits. I got into a crash and hurt my neck. Herniated discs and numbness down into my arms, it was awful. Dr. Sirota he Fixed my neck when i spent last two years with various doctors and physical therapists. Dr. Jon is exceptional; and incredibly knowledgable. This guy is the real deal. No one better in my opinion, and I've been to many Chiropractors. Doctor Jon has many many years of experience. He knew when to adjust my spine, and also knew when not to adjust it and use massage and traction that he does himself. he puts his heart into ever visit and you will feel the difference right away. He talks to you a lot. He explains everything before he does it and makes me feel like i am a friend, not a patient. If you had a car accident and if you are in pain and have tried many physical therapists and M.D's; neurologists that my own lawyer sent me to but didnt work at all, then you want to call and see this guy

Anon

Chiropractor White Plains NY
5
2017-07-19T09:50:15+00:00

Anon

Awesome! Took my No fault auto accident insurance when no one else would. Unbelievable result in 3 visits. I got into a crash and hurt my neck. Herniated discs and numbness down into my arms, it was awful. Dr. Sirota he Fixed my neck when i spent last two years with various doctors and physical therapists. Dr. Jon is exceptional; and incredibly knowledgable. This guy is the real deal. No one better in my opinion, and I've been to many Chiropractors. Doctor Jon has many many years of experience. He knew when to adjust my spine, and also knew when not to adjust it and use massage and traction that he does himself. he puts his heart into ever visit and you will feel the difference right away. He talks to you a lot. He explains everything before he does it and makes me feel like i am a friend, not a patient. If you had a car accident and if you are in pain and have tried many physical therapists and M.D's; neurologists that my own lawyer sent me to but didnt work at all, then you want to call and see this guy
https://www.drsirota.com/testimonials/anon/

Donna Dietz

Dr. Jon Sirota is a very talented doctor. He cured my hiatal hernia. It is very difficult to get relief from a hiatal hernia because very few doctors know how to treat it. Prior to being treated by Dr. Sirota, I went to shttps://www.drsirota.com/wp-admin/post-new.php?post_type=testimonialeveral top MDs for the terrible pain I felt just under my breast bone for months. While they were able to diagnose the hiatal hernia by eliminating all other potential causes through sonograms, blood tests etc., they had no solution. The only option they offered was a very risky surgery that has a low success rate. Thank God Dr. Sirota knew how to treat my condition with a chiropractic manipulation. After a couple of visits, the terrible pain that plague me simple stopped. In addition, Dr.Sirota is an important part of my health maintenance team. He keeps my spine aligned so that I don't have back pain and my spine is in good condition. I highly recommend Dr. Sirota both to relieve pain and also to maintain your health

Donna Dietz

Chiropractor White Plains NY
5
2017-07-19T09:49:22+00:00

Donna Dietz

Dr. Jon Sirota is a very talented doctor. He cured my hiatal hernia. It is very difficult to get relief from a hiatal hernia because very few doctors know how to treat it. Prior to being treated by Dr. Sirota, I went to shttps://www.drsirota.com/wp-admin/post-new.php?post_type=testimonialeveral top MDs for the terrible pain I felt just under my breast bone for months. While they were able to diagnose the hiatal hernia by eliminating all other potential causes through sonograms, blood tests etc., they had no solution. The only option they offered was a very risky surgery that has a low success rate. Thank God Dr. Sirota knew how to treat my condition with a chiropractic manipulation. After a couple of visits, the terrible pain that plague me simple stopped. In addition, Dr.Sirota is an important part of my health maintenance team. He keeps my spine aligned so that I don't have back pain and my spine is in good condition. I highly recommend Dr. Sirota both to relieve pain and also to maintain your health
https://www.drsirota.com/testimonials/donna-dietz/

Margaret Shea

I was very please with my first experience with Dr Sirota. My back was in very bad shape and I walked out feel 40% better. I plan to go back on Saturday for a tune up. But my pain is extremely relieved.

Margaret Shea

Chiropractor White Plains NY
5
2017-07-19T09:48:10+00:00

Margaret Shea

I was very please with my first experience with Dr Sirota. My back was in very bad shape and I walked out feel 40% better. I plan to go back on Saturday for a tune up. But my pain is extremely relieved.
https://www.drsirota.com/testimonials/margaret-shea/

Louise Kaminer

Dr. Sirota shows genuine concern and has a gentle, caring approach. Time is spent on both the presenting problem as well as how it impacts the rest of your quality of life. He educates as he works so you fully understand the process and road to recovery

Louise Kaminer

Chiropractor White Plains NY
5
2017-05-15T08:25:39+00:00

Louise Kaminer

Dr. Sirota shows genuine concern and has a gentle, caring approach. Time is spent on both the presenting problem as well as how it impacts the rest of your quality of life. He educates as he works so you fully understand the process and road to recovery
https://www.drsirota.com/testimonials/louise-kaminer/

Jennifer Suckra

My experiences are always good, great result all the time DR SIROTA is a great chiropractor i would surely recomemmend a frieind or relative.

Jennifer Suckra

Chiropractor White Plains NY
5
2017-07-19T09:46:44+00:00

Jennifer Suckra

My experiences are always good, great result all the time DR SIROTA is a great chiropractor i would surely recomemmend a frieind or relative.
https://www.drsirota.com/testimonials/jennifer-suckra/

James Martyniak

Absolutely wonderful as always.

James Martyniak

Chiropractor White Plains NY
5
2017-07-19T09:45:57+00:00

James Martyniak

Absolutely wonderful as always.
https://www.drsirota.com/testimonials/james-martyniak/

Nannette Morrison

always a pleasure visiting Dr. John

Nannette Morrison

Chiropractor White Plains NY
5
2017-07-19T09:45:10+00:00

Nannette Morrison

always a pleasure visiting Dr. John
https://www.drsirota.com/testimonials/nannette-morrison/

Jacqueline Reinhardt

I can honestly say that Dr. Sirota is simply amazing at what he does. I have been treated by him for may years and I am happy to say without any hesitation that I am virtually pain free!

Jacqueline Reinhardt

Chiropractor White Plains NY
5
2017-07-19T09:44:38+00:00

Jacqueline Reinhardt

I can honestly say that Dr. Sirota is simply amazing at what he does. I have been treated by him for may years and I am happy to say without any hesitation that I am virtually pain free!
https://www.drsirota.com/testimonials/jacqueline-reinhardt/

Brooke Coveney

A great experience every time.

Brooke Coveney

Chiropractor White Plains NY
5
2017-07-19T09:44:05+00:00

Brooke Coveney

A great experience every time.
https://www.drsirota.com/testimonials/brooke-coveney/

Susan Stokes

Dr Jon Is friendly and very professional. He is always very understanding and helpful.

Susan Stokes

Chiropractor White Plains NY
5
2017-07-19T09:43:34+00:00

Susan Stokes

Dr Jon Is friendly and very professional. He is always very understanding and helpful.
https://www.drsirota.com/testimonials/susan-stokes/

Paul Broderick

I went to Dr Sirota for stiffness in my neck. After adjusting me, he gave me a new pillow to try. Not only has the pillow helped my neck, but my wife says I am not snoring any more. If my wife is happy, then I am happy. Thanks Dr Jon.

Paul Broderick

Chiropractor White Plains NY
5
2017-07-19T09:42:48+00:00

Paul Broderick

I went to Dr Sirota for stiffness in my neck. After adjusting me, he gave me a new pillow to try. Not only has the pillow helped my neck, but my wife says I am not snoring any more. If my wife is happy, then I am happy. Thanks Dr Jon.
https://www.drsirota.com/testimonials/paul-broderick/

Larry Grossman

I've been a patient for many years. Jon is not only a really nice person but more importantly a great Chiropractor. He is willing to work with my crazy schedule and whenever I'm there he takes whatever time needed to handle my issues. He really knows what he's doing and keeps me laughing which makes the process easy. I live a distance away but i'd rather make the trip than see anyone else. Of all the Chiropractors I've seen over my lifetime, Jon is the best and i highly recommend him to everyone I speak with whenever the topic comes up!

Larry Grossman

Chiropractor White Plains NY
5
2017-05-15T08:27:03+00:00

Larry Grossman

I've been a patient for many years. Jon is not only a really nice person but more importantly a great Chiropractor. He is willing to work with my crazy schedule and whenever I'm there he takes whatever time needed to handle my issues. He really knows what he's doing and keeps me laughing which makes the process easy. I live a distance away but i'd rather make the trip than see anyone else. Of all the Chiropractors I've seen over my lifetime, Jon is the best and i highly recommend him to everyone I speak with whenever the topic comes up!
https://www.drsirota.com/testimonials/3818/
19
Chiropractor White Plains NY

HOME

CHIROPRACTIC SERVICES

BOOK APPOINTMENT

SUCCESS STORIES

COVID SAFETY

Bestprosintown

SCHEDULE APPOINTMENT

BLOG POSTS

NUTRITION SUPPLEMENTS

PATIENT FORMS

CONTACT US

PRIVACY POLICY

PATIENTS' REVIEWS

Foot-Levelers-chiropractor
purchase your nutrition supplements now
Connect with us
Copyright © 2022 Sirota Chiropractic Offices, White Plains NY & Stamford CT