Chiropractic Care for the
Whole Family

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Our Platinum Care Promise

“If we can’t help you, we will find a doctor who can.”

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
We are welcoming new patients from Clayton and the surrounding areas. Please contact us today to schedule an appointment.

New Patient Health History Forms:

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Please see PDF links below to download patient forms.

New Patient Paperwork

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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.pdf"

New Patient Paperwork in Spanish

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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"

New Patient Auto Accident Form:

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.

Motor Vehicle Accident New Patient 

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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 "New Patient Motor Vehicle Accident.pdf"

Motor Vehicle Accident New Patient Form in Spanish

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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 to Treat a Minor Form for Parent:

Consent Minor New Patient Form

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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"