Relief Is Ahead

Patient Forms
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Welcome!

Download your forms here, and speed up the process.

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.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.
Frequently Asked Questions
How Long Does the Process Take?

Each patient’s individual needs are assessed and each patient’s length of treatment varies.

Does Insurance Cover All Treatments?

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.

Is the therapy painful?

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.

How long is each appointment?

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.

Will I be able to drive myself home?

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.

New Patient Health History Form – Required
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.

New Patient Intake forms (Cash or Insurance Patients)
Informed Consent Form
New Patient Intake Form
Signature On File Form
Pain Diagram (English)

New Personal Injury Intake forms (Motor Vehicle Accident Patients)

New Patient Personal Injury Intake Form
New Patient Personal Injury Intake Part 2 Form
Assignment of Benefits Form
Informed Consent Form
Pain Diagram (English)

Questionnaires

Headache
Neck
Back
Lower Back
Roland-Morris
Back Bournemouth

Quick Links

Get In Touch

(336) 773-1177
Email Us

Visit Us

3333 Brookview Hills Blvd
Suite 101
Winston Salem, NC 27103

Back Pain Relief

Get relief from constant or very painful back pain today. Schedule an appointment.

Our Staff

Learn more about our staff here at Stoetzel Chiropractic in Winston-Salem NC.

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