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919-774-6111
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Exclusive Offer

Exclusive New Patient Offer: Receive your first initial exam and consultation for just $20! Call Today to receive this offer!

Ammons Chiropractic Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


2 Way Release of Records - Required

This form allows us to communicate openly with your primary care physician for health management. 

Download & Print Form


New Patient Review of Symptoms - Required

This lets us know the history and current state of your whole body health.

Download & Print Form


New Patient Functional Rating Index - Required

This lets us know the current state of your pain levels and how they are affected by daily activity.

Download & Print Form


New Patient Medical History - Required

This lets us know more about your past medical history, to better understand how to treat your current conditions.

Download & Print Form

Download the Free AdobeReader®

Services
We strive to provide complete care for our patients. Learn more about all the services we provide.
Make An Appointment
We will do our best to accommodate your busy schedule. Schedule an appointment today!
Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.