[et_pb_section fb_built=”1″ fullwidth=”on” next_background_color=”#ffffff” admin_label=”Header Section” _builder_version=”4.16″ background_color=”#000000″ bottom_divider_style=”ramp” bottom_divider_flip=”horizontal” global_colors_info=”{}”][et_pb_fullwidth_header title=”Relief Is Ahead” subhead=”Patient Forms” text_orientation=”center” button_one_text=”Schedule An Appointment” button_one_url=”\/appointment\/” button_two_text=”Contact Us” button_two_url=”\/contact\/” content_max_width=”640px” _builder_version=”4.16″ title_font=”Oswald|||on|||||” title_font_size=”20px” title_letter_spacing=”3px” title_line_height=”1.5em” content_font=”Lora||||||||” content_font_size=”22px” content_line_height=”2em” subhead_font=”Lora|700|||||||” subhead_font_size=”60px” subhead_line_height=”1.5em” background_color=”rgba(255,255,255,0)” background_image=”https:\/\/winston-salemchiro.com\/wp-content\/uploads\/2021\/04\/Stoetzel-Chiro-Header.jpg” parallax=”on” parallax_method=”on” custom_button_one=”on” button_one_text_size=”16px” button_one_text_color=”#ffffff” button_one_bg_color=”#d29f68″ button_one_border_width=”15px” button_one_border_color=”rgba(210,159,104,0)” button_one_border_radius=”100px” button_one_letter_spacing=”3px” button_one_font=”Oswald|||on|||||” button_one_use_icon=”off” custom_button_two=”on” button_two_text_size=”16px” button_two_text_color=”#ffffff” button_two_bg_color=”rgba(255,255,255,0.35)” button_two_border_width=”15px” button_two_border_color=”rgba(0,0,0,0)” button_two_border_radius=”100px” button_two_letter_spacing=”3px” button_two_font=”Oswald|||on|||||” button_two_use_icon=”off” custom_margin=”|||” custom_padding=”90px||90px||true” animation_style=”zoom” animation_duration=”2000ms” animation_intensity_zoom=”4%” subhead_font_size_tablet=”” subhead_font_size_phone=”50px” subhead_font_size_last_edited=”on|desktop” button_one_border_radius_hover=”100px” button_one_bg_color_hover=”#cc8d66″ button_two_bg_color_hover=”#d29f68″ global_colors_info=”{}” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_one_border_radius__hover_enabled=”on” button_one_border_radius__hover=”100px” button_two_border_radius__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_one_bg_color__hover_enabled=”on” button_one_bg_color__hover=”#cc8d66″ button_two_bg_color__hover_enabled=”on” button_two_bg_color__hover=”#d29f68″][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ admin_label=”Listings” _builder_version=”4.16″ custom_padding=”80px||0||false|false” animation_style=”fade” animation_delay=”200ms” global_colors_info=”{}”][et_pb_row column_structure=”1_2,1_2″ admin_label=”About Row” _builder_version=”4.16″ locked=”off” global_colors_info=”{}”][et_pb_column type=”1_2″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.16″ text_font=”Lora||||||||” text_font_size=”18px” text_line_height=”2em” link_font=”||||||||” ul_font=”||||||||” ol_font=”||||||||” quote_font=”||||||||” header_font=”||||||||” header_2_font=”Lora|700|||||||” header_2_font_size=”50px” header_2_line_height=”1.5em” header_3_font=”Lora|700|||||||” header_3_font_size=”42px” header_3_line_height=”1.5em” header_5_font=”Oswald|||on|||||” header_5_text_color=”rgba(0,0,0,0.4)” header_5_font_size=”20px” header_5_letter_spacing=”3px” max_width=”600px” max_width_tablet=”” max_width_phone=”” max_width_last_edited=”on|phone” custom_margin_tablet=”|70px||70px” custom_margin_phone=”|50px||50px” custom_margin_last_edited=”off|desktop” text_line_height_last_edited=”off|desktop” global_colors_info=”{}”]<\/p>\n
Stoetzel Chiropractic Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.<\/p>\n
[\/et_pb_text][et_pb_button button_url=”\/contact\/” button_text=”Email Us With Any Questions” button_alignment=”left” _builder_version=”4.16″ custom_button=”on” button_text_size=”16px” button_text_color=”#ffffff” button_bg_color=”#d29f68″ button_border_width=”15px” button_border_color=”rgba(210,159,104,0)” button_border_radius=”100px” button_letter_spacing=”3px” button_font=”Oswald|||on|||||” button_use_icon=”off” button_border_radius_hover=”100px” button_bg_color_hover=”#cc8d66″ locked=”off” global_colors_info=”{}” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”on” button_border_radius__hover=”100px” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”on” button_bg_color__hover=”#cc8d66″ button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_button][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text admin_label=”Title” _builder_version=”4.16″ text_font=”Lora||||||||” text_font_size=”18px” text_line_height=”2em” link_font=”||||||||” ul_font=”||||||||” ol_font=”||||||||” quote_font=”||||||||” header_font=”||||||||” header_2_font=”Lora|700|||||||” header_2_font_size=”50px” header_2_line_height=”1.5em” header_3_font=”Lora|700|||||||” header_3_font_size=”42px” header_3_line_height=”1.5em” header_5_font=”Oswald|||on|||||” header_5_text_color=”rgba(0,0,0,0.4)” header_5_font_size=”20px” header_5_letter_spacing=”3px” header_5_line_height=”1.5em” max_width=”600px” max_width_tablet=”” max_width_phone=”” max_width_last_edited=”on|phone” custom_margin_tablet=”|70px||70px” custom_margin_phone=”|50px||50px” custom_margin_last_edited=”off|desktop” text_line_height_last_edited=”off|desktop” locked=”off” global_colors_info=”{}”]<\/p>\n
[\/et_pb_text][et_pb_accordion open_toggle_text_color=”#d29f68″ open_toggle_background_color=”#232220″ _builder_version=”4.17.4″ toggle_font=”Oswald|||on|||||” toggle_font_size=”16px” toggle_letter_spacing=”3px” toggle_line_height=”1.5em” body_font=”Lora||||||||” body_text_color=”#ffffff” body_font_size=”18px” body_line_height=”2em” max_width=”480px” max_width_tablet=”” max_width_phone=”” max_width_last_edited=”on|desktop” custom_margin=”|||” animation_style=”slide” animation_direction=”top” animation_intensity_slide=”5%” border_radii=”on|8px|8px|8px|8px” border_width_all=”0px” global_colors_info=”{}”][et_pb_accordion_item title=”How Long Does the Process Take?” open=”on” _builder_version=”4.17.4″ global_colors_info=”{}”]<\/p>\n
Each patient’s individual needs are assessed and each patient’s length of treatment varies.<\/p>\n
[\/et_pb_accordion_item][et_pb_accordion_item title=”Does Insurance Cover All Treatments?” _builder_version=”4.17.4″ global_colors_info=”{}” open=”off”]<\/p>\n
We accept most insurances but there are specific insurances that may only cover certain services. We recommend patients check with their insurance on what is covered on their plan. Please bring your insurance information to our office so we can verify your benefits.<\/p>\n
[\/et_pb_accordion_item][et_pb_accordion_item title=”Is the therapy painful?” _builder_version=”4.17.4″ global_colors_info=”{}” open=”off”]<\/p>\n
The treatments offered by our clinic alleviate pain and are found by most patients to feel great. Certain treatments may cause minor soreness especially if you have experienced a recent injury, but we do have very gentle treatment methods available to make any potential treatment soreness minimal or none at all.<\/p>\n
[\/et_pb_accordion_item][et_pb_accordion_item title=”How long is each appointment?” _builder_version=”4.17.4″ global_colors_info=”{}” open=”off”]<\/p>\n
How long a visit takes depends on each person’s unique situation. The initial exam and successive exams take more time then visits that are purely treatment in general. We value your time, but also make sure that our quality of care for you is our number one priority.<\/p>\n
[\/et_pb_accordion_item][et_pb_accordion_item title=”Will I be able to drive myself home?” _builder_version=”4.17.4″ global_colors_info=”{}” open=”off”]<\/p>\n
The vast majority of patients are completely fine to drive after treatment but there are unique cases in which the patient needs a driver, such as severe injury, and this can be discussed with the doctor.<\/p>\n
[\/et_pb_accordion_item][\/et_pb_accordion][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ specialty=”on” _builder_version=”4.16″ custom_width_px=”1440px” global_colors_info=”{}”][et_pb_column type=”3_4″ specialty_columns=”3″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_row_inner _builder_version=”4.16″ global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.19.5″ _module_preset=”default” text_font=”Lora||||||||” text_font_size=”16px” text_line_height=”2em” link_font=”||||||||” ul_font=”||||||||” ol_font=”||||||||” quote_font=”||||||||” header_font=”||||||||” header_2_font=”Lora|700|||||||” header_2_font_size=”50px” header_2_line_height=”1.5em” header_3_font=”Lora|700|||||||” header_3_font_size=”36px” header_3_line_height=”1.5em” header_5_font=”Oswald|||on|||||” header_5_text_color=”rgba(0,0,0,0.4)” header_5_font_size=”20px” header_5_letter_spacing=”3px” max_width_tablet=”” max_width_phone=”” max_width_last_edited=”on|phone” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n
New Patient Health History Form – Required<\/strong> New Patient Intake forms (Cash or Insurance Patients)<\/strong> New Personal Injury Intake forms (Motor Vehicle Accident Patients)<\/strong><\/p>\n New Patient Personal Injury Intake Form<\/a> Questionnaires<\/strong><\/p>\n Headache<\/a> [\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.16″ text_font=”||||||||” header_font=”||||||||” header_2_font=”||||||||” header_3_font=”Lora|700|||||||” header_3_font_size=”40px” header_3_line_height=”1.5em” header_4_font=”Lora|700|||||||” header_4_font_size=”17px” header_4_line_height=”1.5em” header_5_font=”||||||||” header_6_font=”||||||||” max_width=”600px” module_alignment=”center” custom_padding=”30px||||false” animation_style=”fade” text_line_height_last_edited=”off|desktop” header_2_font_size_phone=”36px” header_2_font_size_last_edited=”off|desktop” header_3_font_size_tablet=”” header_3_font_size_phone=”36px” header_3_font_size_last_edited=”on|desktop” locked=”off” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][et_pb_blurb title=”Neck Pain” url=”\/neck-pain\/” image=”https:\/\/winston-salemchiro.com\/wp-content\/uploads\/2021\/04\/neck-pain-icon.png” icon_placement=”left” _builder_version=”4.16″ header_font=”Oswald|||on|||||” header_font_size=”14px” header_letter_spacing=”1px” header_line_height=”2em” body_font=”Lora||||||||” body_font_size=”16px” body_line_height=”2em” text_orientation=”center” custom_margin=”|||” animation_style=”fade” animation=”off” global_colors_info=”{}”][\/et_pb_blurb][et_pb_blurb title=”Herniated Discs” url=”\/back-pain\/” image=”https:\/\/winston-salemchiro.com\/wp-content\/uploads\/2021\/04\/herniated-discs-icon.png” icon_placement=”left” _builder_version=”4.16″ header_font=”Oswald|||on|||||” header_font_size=”14px” header_letter_spacing=”1px” header_line_height=”2em” body_font=”Lora||||||||” body_font_size=”16px” body_line_height=”2em” text_orientation=”center” custom_margin=”|||” animation_style=”fade” animation=”off” locked=”off” global_colors_info=”{}”][\/et_pb_blurb][et_pb_blurb title=”Auto\/Work Injury” url=”\/foot-pain\/” image=”https:\/\/winston-salemchiro.com\/wp-content\/uploads\/2021\/04\/auto-work-injury-icon.png” icon_placement=”left” _builder_version=”4.16″ header_font=”Oswald|||on|||||” header_font_size=”14px” header_letter_spacing=”1px” header_line_height=”2em” body_font=”Lora||||||||” body_font_size=”16px” body_line_height=”2em” text_orientation=”center” custom_margin=”|||” animation_style=”fade” animation=”off” locked=”off” global_colors_info=”{}”][\/et_pb_blurb][et_pb_text _builder_version=”4.16″ text_font=”Lora||||||||” text_font_size=”16px” text_line_height=”2em” header_font=”||||||||” header_2_font=”||||||||” header_3_font=”Lora|700|||||||” header_3_font_size=”40px” header_3_line_height=”1.5em” header_4_font=”Lora|700|||||||” header_4_font_size=”17px” header_4_line_height=”1.5em” header_5_font=”||||||||” header_6_font=”||||||||” module_alignment=”center” custom_padding=”30px|0px|||false|” animation_style=”fade” text_line_height_last_edited=”off|desktop” header_2_font_size_phone=”36px” header_2_font_size_last_edited=”off|desktop” header_3_font_size_tablet=”” header_3_font_size_phone=”36px” header_3_font_size_last_edited=”on|desktop” locked=”off” global_colors_info=”{}”]<\/p>\n
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Please print out all the forms associated with your case and have them filled out by your first appointment. If you are unable to print out the forms ahead of time, please arrive to the clinic up to 30 minutes before your scheduled appointment to fill out the paperwork.<\/p>\n
Informed Consent Form<\/a>
New Patient Intake Form<\/a>
Signature On File Form<\/a>
Pain Diagram (English)<\/a>
Insurance Form (Spanish)<\/a><\/p>\n
New Patient Personal Injury Intake Part 2 Form<\/a>
Assignment of Benefits Form<\/a>
Informed Consent Form<\/a>
Pain Diagram (English)<\/a>
Personal Injury Form (Spanish)<\/a><\/p>\n
Neck<\/a>
Back<\/a>
Lower Back<\/a>
Roland-Morris<\/a>
Back Bournemouth<\/a><\/p>\nQuick Links<\/h4>\n
Get In Touch<\/h4>\n