Patient Forms

Elite Chiropractic Center of Clayton offers patient forms online so they can be completed in the convenience of your own home or office and will save you 30 mins. in our office:

Print forms below and fill out the information. You may fax us the printed and completed form or bring it with you to your appointment.
Our fax number is: 919-553-9909

New Patient Paperwork

PDF
Please download, print and bring with you to your next appointment.

This form is for all new patients filing health insurance, medicare, medicaid or self pay (cash).

Download "NEW PATIENT PAPERWORK 2019"

New Patient Paperwork in Spanish

PDF
Please download, print and bring with you to your next appointment.

This form is for all new patients filing health insurance, medicare, medicaid or self pay (cash).

Download "New Patient Form in Spanish.pdf"

Motor Vehicle Accident New Patient 

PDF
If you have been involved in an auto accident please use the following form to let us know details about the accident and the injuries you received during the accident.

Please bring your police report and any other information that may be helpful to your appointment.

Download "MVA New Patient Paperwork 2019"

Motor Vehicle Accident New Patient Form in Spanish

PDF
If you have been involved in an auto accident please use the following form to let us know details about the accident and the injuries you received during the accident.

Please bring your police report and any other information that may be helpful to your appointment.

Download "Motor Vehicle Accident New Patient Form in Spanish.pdf"

Consent Minor New Patient Form

PDF
If your family member who is presenting for treatment is younger than 18, please print and bring in the following completed form.

Download "New Patient Kids.pdf"