7721 Six Forks Road, Suite 138, Raleigh, NC 27615

(919) 846-7004

Patient Forms

New Patient Information

Welcome to Raleigh Specific Chiropractic! Click the links below to download our new chiropractic patient forms. Fill out these forms at home before you come for your first visit!

Please follow the steps below to download and submit your patient forms to our office:

1) Click on one of the links below to download the form
2) Download the PDF file to your computer
3) Open the file on your computer
4) Fill out the form and save it on your computer
5) Upload the form on the website

New Patient Forms

pdf Adult Intake Form
pdf Personal Injury Form
pdf Pediatric Intake Form

Click here to upload your patient forms to our office.


Your First Visit – What To Expect

Health History

A health intake form is completed at your first Chiropractic visit. The intake informs the doctor of your current complaints, and your history of injuries or illnesses.

Consultations

You and your doctor will review your health intake form together. A history of spinal impacts, including auto-accidents, work, recreational and sport injuries is reviewed, along with your current work and daily activity.

Clinical Examination

Your examination will include a thorough posture evaluation, range of motion analysis, sEMG, spinal palpation, and any necessary orthopedic & neurological tests.  This will help determine if subluxations are affecting your health and function.

X-rays & Analysis

Your chiropractic examination may require x-rays. The x-rays reveal the degree of spinal misalignment, the phase of spinal degeneration, significant pathologies, and potential contraindications of care. In our clinic, careful analysis leads to precision measurements. These measurements along with your clinical exam findings enable us to provide you with individualized treatment and optimal adjustments.


Your Second Visit – What To Expect

secondvisit

Explanation/Report of Findings

You will be given a complete report of findings, after your doctor has studied your health history, clinical examination, and x-rays. You will receive education about your spine and nervous system and the specific findings relative to postural imbalances, limited ranges of motion, weak muscles, and positive orthopedic tests results. After the exam findings are explained, your x-rays are reviewed and compared with normal radiographs; helping to provide you with a clear understanding of the problems present.

First Adjustment

After you have received your reports and your doctor has answered your questions, your first chiropractic adjustment will be given (if appropriate). Because we are certified in a variety of adjusting techniques at Raleigh Chiropractic, we can choose the most effective approach to enhance your comfort and your results.


Your Third Visit – What To Expect

thirdvisit

Recommendations Of Care

At your third visit to Raleigh Chiropractic you will receive our recommendations for your best care. The recommendations will vary according to the severity of subluxations present, phase of degeneration, your age, current condition, and history of spinal impacts. Your care plan may also include specific spinal and extremity rehabilitation performed at this clinic. Our goal is to help you reach optimal health through maximum stabilization of your spine. Once stabilization is attained, our goal is to show you how to maintain your spine at it’s best throughout your life.

Family Policy

We are a family practice and we feel honored to be chosen as your family chiropractor. Since many spinal conditions can be hereditary and undetected, it is important that family members of our patients also be checked for vertebral subluxation. Many conditions that adults suffer from, were present when they were children. Chiropractic is for kids too! Early adjustments help children grow into healthy adults. Early correction prevents problems that spinal subluxations can cause if left undetected and uncorrected.


Patient Form Upload

Please use the form below to upload your patient forms. If you have any questions please call 919-846-7004.

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