Gallagher Chiropractic and Wellness offers our patient intake forms online so they can be completed 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.
New Patient Health History Form - Required
This lets us know the history and current state of your health and saves you time by allowing you to fill out the paperwork in the comfort of your own home. We have two options.
Option 1: Download and print forms at home, fill them out and bring them to the office. Use the following links.
Option 2: Online forms. Click on the following link and fill out all your information online. If you choose this option 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 choose 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.
Auto Accident and Workers Comp Information Form
Please complete the following form in addition to the above forms.
Contact Gallagher Chiropractic and Wellness in Charlotte Today!
Gallagher Chiropractic and Wellness is located 7810 Ballantyne Commons Pkwy, #101 Charlotte, NC 28277.