Online Forms

Alternative Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or 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.

Chiropractic Patients - Required Forms

Patient Case History Form

X-Ray Consent Form

Lien Authorization Form

Appointment Reminder Form

Patient Care Guidelines

Please fax a copy of your insurance card with your D.O.B. to 704.799.0935

Special Circumstances - Required Forms

Advance Benefiary Notice 1 (Medicare Only)

Advance Benefiary Notice 2 (Medicare Only)

Minor Consent

Auto Accidents Form

Workers Comp Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!