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Online Forms

Gallagher Chiropractic and Wellness offers our patient intake forms online 

Click on the following link and fill out all your information online.  Be sure to separate different issues.  For example if you have neck and low back pain, when prompted, choose the area of the neck that is bothering you and answer the appropriate questions.  Then choose an additional complaint and select the area of the back that is the problem area and answer the questions for that issue.

This will make sense as you go through the questions.

Let us know if you have any questions.


Don't Want To Complete Your Paperwork Online?

Download the necessary form(s), print them and complete the required information. Fax us, or email us your printed and completed form(s) or bring it with you to your appointment.

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    1. All new patients:  New Patient Intake Forms
    2. If you have neck pain: Neck Pain Index Form
    3. If you have back pain: Back Pain Index Form
    4. If you were in an accident:  Auto Injury and Workers Comp

Contact Gallagher Chiropractic and Wellness in Charlotte  Today!

If you haven't already made an appointment and aren't scheduled to see us yet, Contact us or call us at (704) 542-6500 to schedule an appointment today. 

Gallagher Chiropractic and Wellness is located 7810 Ballantyne Commons Pkwy, #101 Charlotte, NC 28277.

CONTACT US TODAY

We look forward to servicing you and working with for improved health and wellness.

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Office Hours

Our Regular Schedule

Monday:

8:30 am-1:00 pm

3:00 pm-6:00 pm

Tuesday:

8:30 am-1:00 pm

Wednesday:

8:30 am-1:00 pm

3:00 pm-6:00 pm

Thursday:

12:00 pm-6:00 pm

Friday:

8:30 am-2:00 pm

Saturday:

Closed

Sunday:

Closed