Julington Creek Chiropractic & Wellness Center
© 2008-17 All rights reserved Julington Creek Chiropractic & Wellness Center, P.A.
New Patient Information, 4 page form ( rev.2012) All new patients are required to complete our Patient Information form, prior to any treatment. The form includes a medical history portion. Click on the icon to the left to open the form in Adobe and then print the four (4) page document. Bring your completed form to the office on your first visit, this will greatly reduce your time in the waiting room. Existing patients: if there has been a substantial change in your personal information, you may be asked to resubmit a new form, particularly when there has been a change in your health history.
Injury incurred from Motor Vehicle Accident, 5 page form In addition to the new patient form listed above, if your ailment is related to or a result of a motor vehicle accident, then you will be required to complete this five (5) page form prior to treatment. Click on the icon to the left to open the form in Adobe and then print the document. Bring your completed form to the office on your visit.
PATIENT INFORMATION FORMS