Chiropractic and Laser Therapy Center
INFORMATION FOR NEW PATIENTS

(252) 636-2900

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Get a head start! For your convenience, we have provided our new patient forms. Download and print each form. Then, complete the paperwork in the comfort of your home and bring to the office on your first visit. If you would like to fax the forms, please call our office for our fax number.

Let Us Care for You!

OFFICE HOURS
Ready to get started? Call our office at (252) 636-2900 for more information and to make an appointment. If you're unsure whether chiropractic is the right choice for you, we offer a no charge consultation to discuss your problem and determine if chiropractic may help. If you decide to proceed with care in our office, Dr. Carraway will perform an examination, x-rays if necessary, and chiropractic treatment and therapy.
NEW PATIENT PAPERWORK
Page 1: New Patient Registration
Page 2: Medical History Questionnaire
We are a provider in many health insurance networks and accept Medicare. However, each health insurance company and plan has different benefits regarding amount of copay, deductible or coinsurance, number of visits allowed, etc. We will be glad to help verify your benefits for you on your first visit.
INSURANCE
8:00 am - 11:15 am, 1:30 pm - 5:45 pm
8:00 am - 11:15 am
8:00 am - 11:15 am, 1:30 pm - 5:45 pm
8:00 am - 11:15 am, 1:30 pm - 5:45 pm
8:00 am - 11:15 am
Page 3: Review of Systems
Pages 4, 5: Symptoms Questionnaire
Page 6: Medication List