New Patient Paperwork

University Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

Chiropractic Forms

CHIROPRACTIC PATIENT INTAKE FORM - Click to Complete
CHIROPRACTIC PEDIATRIC INTAKE FORMS - Click to Complete

Personal Injury and Medicare Forms

CHIROPRACTIC PERSONAL / AUTO INJURY INTAKE FORM - Click to Complete
NECK DISABILITY INDEX QUESTIONNAIRE - Click to Complete
OSWESTRY LOW BACK PAIN INDEX QUESTIONNAIRE - Click to Complete

Massage Forms

MASSAGE PAPERWORK - Click to Complete

Personal Health Forms

REQUEST TO RELEASE MEDICAL RECORDS - Click to Complete
NOTICE OF PRIVACY ACTS - Click to View
PHI DISCLOSURE - Click to Complete
REQUEST TO ACCESS & REVIEW PHI - Click to Complete
REQUEST FOR AMENDMENT OF PHI - Click to Complete

SPANISH FORMS

Quiropráctica: formulario de admisión del paciente
Quiropráctica: formulario de admisión para niños
Quiropráctica: Formulario de admisión por lesiones personales / automovilísticas
AVISO DE PRÁCTICAS PRIVADAS

OFFICE HOURS

Monday
7:30am - 12:30pm
2:00pm - 6:00pm

Tuesday
2:00pm - 6:00pm

Wednesday
7:30am - 12:30pm
2:00pm - 6:00pm

Thursday
7:30am - 12:30pm
2:00pm - 6:00pm

Friday
8:00am - 1:00pm

Saturday
Closed

University Chiropractic
2717 Western Bypass #109
Durham, NC 27705
(919) 493-1940