We offer our paperwork online so you can complete it in the convenience of your own home. Feel free to contact us if you have any questions or need additional information.
* 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.
Health History
This lets us know what’s happened, but perhaps more important, where do you want to take your health?
Download & Print Form
CONSENT TO EXAMINE Pediatric | Infant New Patient Forms (Age 0-2years) |
Piedactric New Patient Forms (Age 3-10 years) |Patient Intake Forms
If your health issue is the result of a car accident, we need some additional information.
Download & Print Form
Motor Vehicle Accident Form | Patient Intake Forms
Welcome to the Druzbik Family Chiropractic new patient center!
We understand that arriving at a doctor's office for the first time can be nerve racking. If you've never experienced chiropractic care before, you may not know
what to expect when you come to our Statesville chiropractic office for the
first time. Filling out paperwork, learning new faces and names, and getting to know your way around the office can be an overwhelming experience.
That's why at Druzbik Family Chiropractic our aim is to remove any unnecessary stress or tension and make you feel comfortable during your visit with our chiropractor.
In this area of the website, you will be able to take care of items necessary for your visit prior to arriving. If you have any questions at any time, please don't hesitate to contact our Statesville chiropractic office at (704) 878-9744!