If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

Contact us using the form or call us at (864) 882-9700

THIS ---->https://dixonchiropracticsccom.chiromatrixbase.com/new-patient-health-history-form.html

Office Hours

DayMorningAfternoon
Monday10:00 - 12:002:00 - 6:00
TuesdayClosedClosed
Wednesday10:00 - 12:002:00 - 6:00
ThursdayClosedClosed
Friday10:00 - 12:002:00 - 6:00
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
10:00 - 12:00 Closed 10:00 - 12:00 Closed 10:00 - 12:00 Closed Closed
2:00 - 6:00 Closed 2:00 - 6:00 Closed 2:00 - 6:00 Closed Closed

Office Hours

No Contracts to sign - Ever

​Most Insurance Accepted

No classes to attend

Hands-on Adjustment on first visit

Appointments available after 6pm

Female Chiropractor

Nutritional Testing


Testimonial

I was referred by my husband and she has helped me out since day one, I go to her for all of my back/neck issues and for just a good ole adjustment. Highly recommended.

M.E.W.
Seneca, SC

Newsletter Sign Up