New Patient Forms

Please print out the applicable new patient paperwork forms below, fill them out, and
bring them with you to your first appointment.

You will enjoy the time you save by taking care of it ahead of time.

Be sure to bring your insurance card with you, too.

New Patient Welcome Form To be filled out by all new patients. (PDF Format)	New Patient History Intake-Form To be filled out by all new patients. (PDF Format)
If this injury is related to an auto injury, please use the form below. New Patient Auto Injury Questionaire (PDF Format)	If this injury is related to an auto injury, please use the form below. Informatcion de Accidente de Coche (PDF Format)

(Adobe Acrobat Reader is required.)

Because You Haven't Got Time For The Pain!

Our Winston-Salem office is conveniently located to serve those from Bethania, Clemmons, Lewisville, Rural Hall, Walkertown, High Point, Wallburg, Jamestown, Clemmons, Lewisville, Farmington, Colfax, Deep River, Walkertown, Walnut Cove, Rural Hall, Tobaccoville, Yadkinville, Welcome, Lexington, King, Pilot Mountain, Thomasville, Kernersville, Archdale, Vienna and surrounding areas..

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Salama Chiropractic Winston Salem Office
1515 Hanes Mall Blvd.
Winston-Salem, NC 27103
Phone: 336-773-7373
Fax: 336-765-7006

© 2010 Salama Chiropractic
Greensboro, North Carolina (NC) Chiropractors - Oak Ridge & Winston-Salem.