For your convenience, forms may be completed prior to your appointment.
All patients please complete Registration, Health Questionnaire and Office Policies. Our care will be most effective for you if you provide a comprehensive medical history, including any care obtained outside of our practice. This includes current medications, allergies, visits to specialists, past medical history, health status, behavior health care, recent test results, self-care information and records from recent hospitalizations, specialist care, or emergency department visits.
To transfer your medical records to us, please call us at 919-378-1492. A member of our front desk team is happy to help you. We can also speak to you about this in person.
Please bring your insurance card, co-pay, and all medications (prescription or over the counter) to all visits.
- Adult Registration
- Pediatric Registration
- Adult Health Questionnaire
- Pediatric Health Questionnaire
- Office Policies
- Chiropractic Intake
Pediatric Well Visit Questionnaires
For well child checkups, please complete the appropriate form for your child's age and bring to your visit.
- Edinburg Postnatal Depression Screening
- ASQ 2 months
- ASQ 4 months
- ASQ 6 months
- ASQ 9 months
- ASQ 12 months
- ASQ 15 months
- ASQ 18 months
- M-CHAT Screening for Autism (age 16-30 Months)
- ASQ 2 Years
- ASQ 3 Years
- ASQ 4 Years
- ASQ 5 Years
Child Development Information
Activities for parent and child to promote physical, social, and emotional growth and learning
- Activities for your child 1 - 4 Months
- Activities for your child 4 - 8 Months
- Activities for your child 8 - 12 Months
- Activities for your child 12 - 16 Months
- Activities for your child 16 - 20 Months
- Activities for your child 20 - 24 Months
- Activities for your child 24 - 30 Months
- Activities for your child 30 - 36 Months
- Activities for your child 36 - 48 Months
- Activities for your child 48 - 60 Months
- Activities for your child 60 - 66 Months
ADD and ADHD Screening
First visit for ADHD evaluation:
Follow up ADHD visits: