New Patient Forms

For your convenience, we have provided an online version of our initial history form for both adults and children. They need to be completed and brought with you on your first visit. If any part of the form does not apply to you, write : N/A in the blank. If you don't have use of a printer at home, we will have you scheduled a little bit earlier for your appointment so you can complete it in the office. Just make sure when you schedule that we know you need to do this.

Please note: we do not handle work-related or accidental injuries: car accidents, slips and falls, etc. that involve any type of lawsuits or legal involvement. Relieving spinal pain, and restoring spinal function and quality of life is our primary focus.

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

And finally, being 'on time is essential for the doctor to complete everything he needs to do on your first visit. 

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.