Patient Forms

Application Forms

Thank you for choosing Upper Cervical Wellness Center

If you are unable to complete the online forms that are sent to you once you’ve scheduled a new patient appointment, feel free to print these .pdf forms 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.