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3230 Prosperity Church Rd, Ste 203

Charlotte, NC 28269

(704) 971-3275

Online Forms

New Patient Forms

Mallard Creek Chiropractor New Patient Paperwork

Let us know if you have any questions about our forms

We offer our paperwork online so you can complete it in the convenience of your own home. Feel free to contact us if you have any questions or need additional information.

  • 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.


Health History

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

New Patient Questionnaire

Automobile Accident

If your health issue is the result of a car accident, we need some additional information.

Auto Accident Questionnaire



Download the Free Adobe Reader®


Jaffe Chiropractic | (704) 971-3275

Locations

Find us on the map

Office Hours

Our Regular Schedule

Primary Office

Monday:

9:30AM – 1:00 PM

3:00PM – 6:00PM

Tuesday:

9:30AM - 1:00PM

3:00PM – 6:00PM

Wednesday:

9:30AM - 1:00PM

3:00PM – 6:00PM

Thursday:

9:30AM - 1:00PM

3:00PM – 6:00PM

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. You may access the Nondiscrimination and Accessibility notice here