Online Forms

Quint Chiropractic 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. This added convenience of having your information and paperwork already filled out will save approximately 15 to 20 minutes of your time during your first appointment. This will significantly decrease time needed in office for your fist visit! If you have any questions or difficulties with printing these forms out online, please do not hesitate to call our office so we may further assist you.

For the most efficient new patient experience possible at your first appointment, we kindly ask all of our new patients to consider the following items:

1. Download, print, and fill out ALL pages of the new patient paperwork as thoroughly as possible prior to arriving to your new patient appointment.  We will not be able to begin your appointment until all necessary paperwork is filled out in full.

2. In the event you are unable to have all of the necessary new patient paperwork completed prior to your arrival for you appointment, please plan on arriving to our office at least one half hour (30 minutes) early and we will be happy to supply you with all necessary paperwork to fill out prior to your scheduled appointment time.

3. If you arrive to your appointment without all necessary paperwork completed and without enough time before your scheduled appointment to complete your new patient paperwork, your new patient appointment may have to be rescheduled to another date and time out of respect for patients with scheduled appointments after your scheduled appointment.

4. Please bring with you to your new patient appointment an acceptable form of photo ID, as well as any cards pertaining to your current/active insurance policy you wish for our office to file on your behalf.

5. If you have had any recent studies performed pertaining to your current condition (X-rays, MRI, CT scan, etc.), please look to secure these items in hand prior to your appointment and bring them to your initial appointment if possible.

6. If your first visit to our office for care is regarding a recent MOTOR VEHICLE ACCIDENT, please bring any information you may have pertaining to the accident.  This includes items such as the accident report, drivers exchange form, any third-party information pertaining to the at fault party, and any information regarding any legal representation you may have retained for the handling of your accident.

  • Our forms must be open and read with AdobeReader® software. 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.
  • You may either fax us your printed and completed form(s) to (910) 392-8628, or simply bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Motor Vehicle Accident Intake Forms - Required

These forms include areas of which will tell us more about the details of the motor vehicle accident. Any other information that you may have in regards to the accident such as the driver exchange form, accident report, or any other medical records/images from physicians you have visited since the accident will also be very helpful.

Download & Print Form



Download the Free AdobeReader®

Contact Us Today

We Look Forward to Hearing From You

Locations

Find us on the map

Office Hours

Our Regular Schedule

Primary Office

Monday:

8:00 am-12:00 pm

2:00 pm-6:00 pm

Tuesday:

12:00 pm-6:00 pm

Wednesday:

8:00 am-12:00 pm

2:00 pm-6:00 pm

Thursday:

8:00 am-12:00 pm

2:00 pm-6:00 pm

Friday:

By Appointment Only

Saturday:

Closed

Sunday:

Closed