New Patient Forms

For your convenience, we have provided the initial history form for adults and children. They are available for you to download and complete prior to your office visit. Please make sure to bring it with you. If anything doesn’t apply to you, please mark N/A for not applicable. You can also call our office and we will email a copy of this form to you.

Please note that we do not make a practice of providing care for work-related or accident injuries sustained during an automobile collision, etc. We provide care for individuals that want to improve their health by having a healthier spine and nervous system. Restoring function and quality of life is our primary focus. Their are other offices that are better suited to navigating the legal system in order help assist injured patients optimize their personal injury settlements.

Our HIPAA policy is also available to print out as well.

Please make sure you are on time as there are other forms to complete and the doctor wants to be able to spend the full amount of time he has reserved to meet with you!

We look forward to seeing you!

Please complete all forms (in English,please), prior to your appointment.


Providing Chiropractic care for Garner, Raleigh, Clayton & Smithfield areas.