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New Patient Forms

New Patients

Please print and fill out the necessary new patient forms below:

• New Patient Intake Form – download here

• Quadruple Visual Analogue Scale – download here

• Activities of Daily Living – download here

• Health Background – download here

 

IN ADDITION TO THE ABOVE FORMS:

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

Existing Patients

Please fill out the forms below:

• Progress Evaluation – download here

• Quadruple Visual Analogue Scale – download here

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

Pediatric Patients – Please fill out the forms below:

• Consent to Treat a Minor – download here

• Patient Intake Form – download here

• Pediatric History – download here

 

Motor Vehicle Patients – Please fill out the forms below:

• New Patient Intake Form – download here

• Motor Vehicle Patient – download here

• Quadruple Visual Analogue Scale – download here

• Activities of Daily Living – download here

• Health Background – download here

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

“I travel 40 minutes to this office because of the excellent care I get. I never leave in pain and I feel like I’m a person here… not just a number. I can’t say enough good things. They are the best and I never thought I would say that. I have finally found the best chiropractor in South Carolina.” – Peggy
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