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Southeast Functional Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

***New Patient Forms-- STANDARD Chiropractic Care and WELLNESS-Required

This lets us know the history and current state of your health and if relevant, your wellness care. Here are the forms: Download & Fax/Email or Bring in Forms. Note: Most of your paperwork will be done on a kiosk in the office.

Nutritional Counseling Forms Only

Nutritional counseling patients fill out this extensive file of forms which also asks that prior medical records of your health concerns and blood work are sent to us before your visit. Here is the Nutritional Intake Forms: Download & Fax/Email or Bring in Forms



Download the Free AdobeReader®

Exclusive Offer

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New patient SPECIAL $75! ($140 value)

​For a limited time only!!!

*Includes history of complaint, examination, review of findings/prognosis, explanation of treatment plan and first treatment if performed on same day. 

*Does not apply to medicare, medicaid or any other insurance.

Sign-up using the form or call us at 251-375-0012 to take advantage of this exclusive offer.

THIS ---->https://daphnechiropractor.com/online-forms.html

Best Daphne, AL Practices in Chiropractic

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