Online Forms

Piedmont Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or 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.

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? Let us know!

Download & Print Form



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We look forward to hearing from you

Office Hours

Our Regular Schedule

Monday:

9:00 am-12:30 pm

2:30 pm-6:00 pm

Tuesday:

9:00 am-12:30 pm

2:30 pm-6:00 pm

Wednesday:

9:00 AM-12:30 pm

2:30 pm-6:00 pm

Thursday:

9:00 AM-12:30 pm

2:30 pm-6:00 pm

Friday:

9:00 AM-12:00 pm

Saturday:

Closed

Sunday:

Closed

Locations

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Testimonials

  • "Affordable and works! Dr States explains things very well in a matter that doesn't make you think your body is falling apart. You get seen before your appointment and there isn't any waiting!"
    Jessica G.
  • "After my car wreck I was unable to turn my head and was in severe pain! Dr. States is amazing, she has worked with me and I'm so happy with my progress this far and am confident that when I complete the care plan I'll be better than I was prior to accident! Will definitely be coming back for routine adjustments!"
    Barbara W.

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