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Online New Patient Paperwork

We offer our paperwork online so you can complete it in the convenience of your own home. Call us or click here to email us your questions!

New Patient Forms

This lets us know what’s happened, but perhaps more important, where do you want to take your health?

Complete your New Patient Forms Online

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Additional Forms

Please complete using black or blue ink.

Headache Disability Index

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Head Injury Scale HIS-R

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Concussion Intake

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Rivermead Post Concussion Symptoms Questionnaire

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Headache Impact Test

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Neck Disability Index

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CORE-Q

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SCAT2 – Sport Concussion Assessment

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SCAT3 – Child Sport Concussion Assessment

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Fullerton Advanced Balance (FAB) Scale

pdf icon  Download & Print Form

Activities Balance Confidence (ABC) Scale

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Fear of Falling Avoidance Behavior Questionnaire

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Fatigue Severity Scale

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Dizziness Handicap Inventory

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Lower Extremity Functional Scale

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PTSD CheckList – Civilian Version

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PTSD CheckList – Military Version

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Oswestry Low Back Pain Disability Questionnaire

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Hamilton Rating Scale for Depression

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Notice of Privacy Practices

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Hilton Head Chiropractor | (843) 681-8001