We can help you!

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Fax us your printed and completed form(s) to (864)268-8198 or bring the completed them with you to your appointment.
  • If you want our staff to check your insurance benefits for chiropractic we need you to provide us with your insurance information before your first visit to allow sufficient time for our staff to get this information from your insurance company.  

Chiropractic New Patient Forms:

-Patient Intake Form

-Chiro Consent From Treatment

-HIPAA Privacy Practices

-Acceptance of Privacy & Financial Policy

MLS Laser Therapy New Patient Forms:

-Patient Intake Form

-MLS Laser Consent for Treatment

-HIPAA Privacy Practices

-Acceptance of Privacy & Financial Policy

Medicare Patients - Additional Form:

Additional Forms for New Auto Accident Patients (*also fill out the Chiropractic New Patient Forms above):
Legal Assignment of Benefits *Please note that Auto Accident patients must pay in full for all services rendered, and we will provide you with reimbursement documentation, unless you have an attorney handling your case who agrees to protect and pay our bill for services. Attorney representation and bill protection proof must be provided prior to receiving treatment in order to hold a bill.

Other Forms:

EZ Pay Signature On File Authorization Form

ChiroHealthUSA Discount Medical Plan Membership Information

Patient Financial Responsibility Policy

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