We greatly suggest that you complete the appropriate form(s) below prior to visiting our office. It will save you time on your first visit or when a new condition needs to be evaluated. Please make every efforts to answer each of the sections, and make sure you completed all pages associated with the form.

To speed up your first visit process even more, you can fax your completed form(s) to our office at (251) 414-5104. We also suggest that you fax a copy of your insurance card(s) so we can verify your chiropractic coverage. Insurance verification alone can take up to 45 minutes depending on your carrier.

New Patient should complete forms 1 & 2

Car accident patients should complete forms 1, 2, & 4

Active patients with a new condition should complete form 3

1. Patient Introduction Form

2. General Health Information

3. Patient History Update Form

4. Motor Vehicle Collision Injury Form

If you have a specific condition you may want to also complete the following questionaire(s) and bring it to the office for the doctor to review.

Headache Questionnaire Form

For our regular patient who need a nutritional evaluation please complete the Symptom Survey Form below and fax it to our office at (251) 414-5104.