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New Patient Forms

Select your doctor's name below to navigate to their forms required for your first visit to the practice. To save time, please fill out forms and bring them with you to your appointment.

Dr. Baldy&Houfek
Dr.Lancaster&Sullivan Dr. Case-Luca Dr. Ferez Dr. Houfek
Dr. Krasnov&Houser Dr. Presas Dr. Ransone Dr. Redd
Dr. Schmid Dr. J. Smith Dr. S. Smith Dr. Wallace


Dr. Baldy

Submit Form Online


Dr. Case-Luca

Submit Form Online


Dr. Ferez

Initial Consultation Form

Personal Health History Form

Neck Index Form

Back Index Form


Dr. Houfek

Submit Form Online


Dr. Krasnov

New Patient Forms

Work Injury Form

Personal Injury Form


Dr. Presas

New Patient Forms

Personal Injury Form

Work Injury Form


Dr. Ransone

New Patient Intake Form

Assignment of Benefits Form

MD Communication Form

Disclosure Authorization

Informed Consent Form

Insurance Assignment Policy

Oswestry Disability Form

Review of Systems Form

Headache Index Form

Neck Pain Index Form

Personal Injury Information Form

Personal Injury Questionnaire Form


Dr. Redd

New Patient Health History Form

Patient Information Update Form

Auto Accident Injury Form

Personal Injury Form


Drs Lancaster and Sullivan

New Patient Form


Dr. John Smith

New Patient Forms


Dr. Sean Smith

New Patient Forms


Dr. Schmid

New Patient Health History

Consent to Treat Form

HIPAA Policy Form

Insurance Assignment Form

MD Communication Form

Direct Payment Form

Auto Accident Questionnaire Form

Lower Back Questionnaire Form

Neck Disability Questionnaire Form

Personal Injury Information Form


Dr. Wallace

Submit Form Online

Office Locations

Cary, NC Chiropractor

Dr. Chris Sullivan
Dr. John Lancaster

Phone: (919) 467-7797

Saturday Appointments Available from 8am-12pm


Clayton, NC Chiropractor

Dr. Nicholas Ferez

Phone: (919) 550-9355

*Saturday Appointments can be arranged by calling our office.


Durham, NC Chiropractor (Durham Chapel Hill Blvd)

Dr. Michael Krasnov
Dr. Alex Allard

Phone: (919) 383-9890


Durham, NC Chiropractor (Southpark Drive)

Dr. Arturo Presas

Phone: (919) 572-2312


Fuquay Varina, NC Chiropractor

Dr. Brook Wallace

Phone: (919) 577-0660


Raleigh, NC Chiropractor - Creedmoor & Crabtree

Dr. Graham Clements Chiropractor

Phone: (919) 390-2444

Garner, NC Chiropractor

Dr. Betsy Case-Luca

Phone: (919) 772-1113


Raleigh, NC Chiropractor (Midtown Raleigh)

Dr. Greg Baldy
Dr. Alan Houfek

Phone: (919) 787-8883


Raleigh, NC Chiropractor (Celebration Square)

Dr. Brian Ransone
Dr. Matthew Schmid

Phone: (919) 847-3122


Raleigh. NC Chiropractor(Capital Blvd)

Dr. John Smith
Dr. Sean Smith

Phone: (919) 878-8848

Saturday Appointments Available from 8am-12pm


Wake Forest, NC Chiropractor

Dr. Russ Redd Chiropractor

Phone: (919) 556-2014