Forms

Becoming a Patient is Simple

First visit Exam is only $175 (does not include any treatment).

Getting well with chiropractic and nutritional support has never been so simple
    1. Call to make your appointment, 434-481-2012
    2. Download your NEW PATIENT FORMS below. Completely fill out all the pages of the form BEFORE you come in for your first appointment.
    3. Complete the Symptom Survey at this online link THEN PRINT IT OUT AND BRING IT IN WITH YOU ON YOU FIRST VISIT.  Or you can fill it out in the office when you arrive if you prefer.
    4. Download and Print out the Administration forms at the link listed below.  Fill them out and sign and bring them in with you or we can have you fill them out in the office before you appointment.
    5. NOW fill out the form below and make sure to click the “Submit” button at the end of the form.  You will get a confirmation page telling you it was submitted if you did it correctly.

Other Patient Forms and Downloads