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. It is secure and none of your answers are saved on the website and no identifying information is entered on this link.  It will take you approx. 5-10 minutes.  You will print it out when you are finished and bring it in with your other forms.  Or you can fill it out in the office when you arrive if you prefer.

Download the Administration forms, fill them out and sign and bring them in with you.  Fill in your History form here or download the form below and bring it in AFTER you have filled it in completely.

Other Patient Forms and Downloads