Intake Forms

 

blk-phone(919) 367-2828

Peakway Market Square, 800 W. Williams St. Ste 201, Apex, NC 27502

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Patient Intake Forms

 

Welcome to Creech Chiropractic, where you and your family will receive the best care available!

 

STEP 1:

Prior to your appointment, please select the appropriate link below to complete and submit the new patient forms.

 New Patient Forms  
Adult New Patient Form Complete Online  
Pediatric New Patient Form Complete Online  
Personal Injury Patient Form Complete Online  

The following links are provided for your convenience in filling out your forms:

 

STEP 2: 

Adult New Patient
Adult new patients, please print and complete the below forms as well as the adult new patient form via the link in STEP 1.
1.    pdfhippa_appointment_reminders_pg_1.pdf
2.    pdfhippa_consent_for_disclosure_pg_2.pdf
3.    pdfInformed_Consent.pdf
4.    pdfInsurance_Disclaimer_9-17-2012.pdf

 

Pediatric Patient
Pediatric new patients, please print and complete the below forms as well as the pediatric new patient form via the link in STEP 1.

1.    pdfConsent To Treat Minor
2.    pdfHippa Appointment Reminders 1
3.    pdfHippa Consent for Disclosure 2
4.    pdfInformed Consent
5.    pdfInsurance Disclaimer 9-17-2012

 

Personal Injury
Personal injury patients, please print and complete the below forms as well as the personal injury patient form via the link in STEP 1.

 1.    pdfHippa Appointment Reminders 1
2.    pdfHippa Consent for Disclosure 2
3.    pdfInformed Consent
4.    pdfInsurance Disclaimer 9-17-2012
5.    pdfPI Office Policy
6.    pdfLien rev 6-16-2012

 

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Intake Forms

Save time by downloading our intake forms.
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Payment Options

Our payment options are flexible and convenient.
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My First Visit

Find out what to expect at your first visit.
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Photo Gallery

Photo gallery of Creech Chiropractic.
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Our Office Hours

Mon 8am-12pm 1:30pm-5:30pm
Tue
8am-12pm 1:30pm-5:30pm
Wed closed 1:30pm-6pm
Thur
8am-12pm 1:30pm-5:30pm
Fri
8am-12pm closed
Sat closed closed
Sun closed closed

3D Patient Education

Interactive 3D Education. Subluxation, Degeneration and Nervous System Interference.

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Get Directions

Need help finding us? We make it easy for you to find us with google maps.

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Contact Us

(919) 367-2828

 

markerPeakway Market Square,
800 W Williams St.
Suite 201
Apex NC, 27502
This email address is being protected from spambots. You need JavaScript enabled to view it.