COVID-19: Our team has implemented changes to be compliant with CDC guidelines and are currently making/keeping appointments to see patients who are not running a fever, do not have a dry cough, and are not suspected to be infected. As we continue to follow our state board as to the role of chiropractors in the current pandemic, keeping safety of our patients and staff top priority, we thank you for understanding this is subject to change.

(704) 882-1488

Patient Forms

Application Forms

Thank you for choosing Upper Cervical Wellness Center

You can fill out the application online and print, or print and fill them out by hand.  Once all four forms are completed, simply email them to or fax them to (704) 882-1448, or deliver them to our office.

Download Forms Here

Chiropractic, Nutrition & Wellness Patient Intake Forms

Please print and complete your Chiropractic and Nutrition patient-forms before you come into the office.