We can see you today!  Never a charge for a consultation.

336-274-3500

3410 West Wendover Aveue • Suite A
  Greensboro, North Carolina
 27407

New Patient Forms

Don't Live Life in Pain!

Please fill out the applicable new patient forms below.
You will enjoy the time you save by taking care of it ahead of time.
Be sure to bring your insurance card with you, too.

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NON-AUTO INJURY PATIENTS Fill Out ONLY THE TWO FORMS
 In The
TOP "REGULAR PATIENTS" Section
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AUTO INJURY PATIENTS Fill Out ONLY THE THREE FORMS
 In The BOTTOM "AUTO INJURY PATIENTS" Section
 
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  ALL FORMS BELOW OPEN IN A NEW, SECURE BROWSER WINDOW

Regular Patients (Non-Auto Injury Patients)

To be filled out by all new Regular Patients.

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To be filled out by all new Regular Patients.

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***Auto Injury Patients***

New Patient Auto Injury Welcome Form

To be filled out by all new Auto Injury Patients.

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New Patient History Intake Form

To be filled out by all new Auto Injury Patients.

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To be filled out by all new Auto Injury Patients.

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