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Atlantic Spinal Rehab and Wellness clinic offers our New Patient Forms online so they can be completed in the privacy of your own home or office. You then have the option of bringing them to your consultation or faxing them to the office at (910) 395-2472.

If you have any questions while you are completing these forms, please call our office at (910) 395-2774.  

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

Medical Record Patient Request / Release Form 

In need of your Medical Records OR need them sent somewhere?  Click the links above!

Automobile Accident Form - Auto Accident / Workers Compensation Form

In an automobile accident or incident at work?  Links above provide all the information we need to get you started with the best care to your recovery. 

AdobeReader® is required for the Member Wellness Registration form. If you do not already have AdobeReader® on your computer click below to download!

Download the Free AdobeReader®