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New Patient Forms


 

Charlotte Chiropractic and Rehab offers patient forms online so they can be completed in the convenience of your own home or office.

 
  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary forms from the list below that pertain to your visit, print them out and fill in the required information.
  • Bring them with you on your first appointment.

 

New Patient Intake Form

Completion of this form helps us to understand your health history and the current state of your health. What questions, concerns or goals regarding your health and wellness can we help you with? Let us know — we’re here to help you!­

Download and Print Form

Location
Charlotte Chiropractic and Rehab
7810 Ballantyne Commons Pkwy, #101B
Ballantyne

Charlotte, NC 28277
Phone: 704-413-6118
Fax: 704-659-4913
Office Hours

Get in touch

704-413-6118