Get a Second Opinion
Chiropractic Consultation Form
Instructions and policies:

Instructions:
To maximize your time with our Chiropractor, Please answer all questions fully and honestly. When you are finished, please press "submit". Our staff will email you back with two appointment choices for your consultation with our Chiropractor. Please select the one that is most convenient for you, and "submit".
You do NOT have an appointment until we confirm your appointment time with our chiropractor and EMAIL YOUR APPOINTMENT TIME BACK TO YOU. You must than agree to this appointment time, by replying to the email we send to you. Once we receive your email with the confirmation back, your time is booked.

Your Consultation time allowance is 15 minutes from start to finish. If you elect to speak with our chiropractor for more than your time allowance, the rate is an additional $29.99 for every 15 minutes whether you utilize the full 15 minutes or not, the rate is the same and must be prepaid. The Consultation will begin with a call at the designated time to the number you specify, and end within 15 minutes from your appointment time. You will be charged $29.99 at the beginning of your appointment time, so have your Credit Card ready. We accept Amex; Visa; Master Card; and Discover.

The Doctor will initiate the conversation with this format:

• Your chief complaint

• Your past medical history regarding this problem.

• What you have done so far

• Other questions

• Recap of what was said

• Suggestions* for which doctors' you should follow up with and/or other recommendations*
  

Rescheduling your appointment:
24 hours advanced notice is required to re-schedule


* Remember, this consultation is not a substitute for a thorough examination and visit with your Chiropractor, Medical Doctor or other health care professional and only should only be used as another opinion.
Please answer these questions and press the "submit" button. Our staff will email you with two choices for your consultation.
Please make your selection and re-submit. Once your consultation is scheduled you will receive a consultation confirmation.
This is the time for your telephone consultation.