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Patient Forms

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

 

Our Location

800 W Williams St. Suite 201 | Apex, NC 27502

Office Hours

Find Out When We Are Open

Monday:

8:15 am-12:00 pm

1:30 pm-5:30 pm

Tuesday:

8:15 am-12:00 pm

1:30 pm-5:30 pm

Wednesday:

1:30 pm-5:30 pm

Thursday:

8:15 am-12:00 pm

1:30 pm-5:30 pm

Friday:

8:15 am-12:00 pm

1:30 pm-3:00 pm

Saturday:

Closed

Sunday:

Closed