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100 Year Lifestyle Chiropractor in Cary NC • Phone: 919-322-4383
Make Your Health a Priority!

Patient Forms



NEW PATIENT FORM

Please complete this form if you are a new patient to our practice.



FUNCTIONAL NUTRITION FORM

Please complete this form if you are a new Functional Nutrition patient.



NEW PEDIATRIC PATIENT FORM

Please complete this form for any new patients 12 years old and under.



NEW MASSAGE PATIENT FORM

Please complete this form if you are a new medical massage patient.



AUTO INJURY INTAKE FORM

Please complete this form if you have been in an auto accident and are seeking care under an active claim.



NOTICE OF PRIVACY PRACTICES

Here is our full Notice of Privacy Practices