Advanced Chiropractic Center

106 New Edition Court

Cary, NC 27511

919.460.8593

Insurance and payment information

Save time by downloading and completing the following forms prior to arriving for your first

appointment.

New Patient Questionnaire

You can print and complete the New Patient Questionnaire or complete the PDF form using

Acrobat Reader, print the completed form, and bring it with you to your first appointment.

Health Questionnaires

Please print and complete the following PDF forms and bring them with you to your first

appointment.

•  Patient Health Questionnaire

•  Lower Extremity Functional Scale (LEFS)

•  Disabilities of the Arm, Shoulder and Hand (DASH)

2011