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910-303-2690

A Healthy Back offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Health History

This lets us know what’s happened, but perhaps more important, where do you want to take your health?

Download & Print Form


Automobile Accident

If your health issue is the result of a car accident, we need some additional information.

Download & Print Form


Worker’s Compensation

If your health issue is the effect of an injury at work, this information will help us help you.

Download & Print Form



Download the Free AdobeReader®

Sign up using the form or call 910-303-2690 to make your appointment.

Office Hours

DayMorningAfternoon
Monday8:00am5:00pm
Tuesday9:00am2:00pm
Wednesday9:00am2:00pm
Thursday8:00am5:00pm
Friday9:00am12:00pm
SaturdayClosedClosed
SundayClosedClosed

After Hours: On Call until 8:00pm every day. 910-486-9511

What can we help you find?