Forms for New Patients
We have a limited number of new patients appointments available per week, please call us at (843)249-6543 to reserve your appointment. This appointment will last between 30 to 60 minutes. We are unable to see new patients as walk-ins due to other patient appointments. Please print, fill out, and bring these forms with you to the appointment. Without these forms, you will need to arrive 15 to 30 minutes before your appointment to fill out paperwork.
New Patients Forms
Patient Information and Health History
Consent for Chiropractic Care
Assignment Lien and Authorization
Consent for Use or Disclosure of Health Information
Notice of Privacy Practices (print if you need copy)
Notice of Privacy Policy Signature Page
New Children (12 and under) Forms
Minor Patient Information and Health History
Consent for Chiropractic Care
Consent for X-Ray
Assignment Lien and Authorization
Consent for Use or Disclosure of Health Information
Notice of Privacy Practices (print if you need copy)
Notice of Privacy Policy Signature Page
New Medicare Patients Forms
Patient Information and Health History
Consent for Chiropractic Care
Consent for Use or Disclosure of Health Information
Advanced Beneficiary Notice of Noncoverage
Medicare Authorization for Signature of File
Notice of Privacy Practices (print if you need copy)
Notice of Privacy Policy Signature Page
Accident (auto, slip, or fall) / Workers Comp
Patients Forms
Patient Information and Health History
Accident / Workers Comp Forms
Consent for Chiropractic Care
Assignment Lien and Authorization
Consent for Use or Disclosure of Health Information
Notice of Privacy Practices (print if you need copy)
Notice of Privacy Policy Signature Page