New Patient Paperwork
Jaffe Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print them out and fill in the required information.
- Fax us your printed and completed form(s) or bring them 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?
Historia Medica
Esto nos permite saber lo que sucedió, pero quizás lo más importante, ¿adónde quiere llevar su salud?
Automobile Accident
If your health issue is the result of a car accident, we need some additional information.
Accidente de automóvil
Si su problema de salud es el resultado de un accidente automovilístico, necesitamos información adicional.
Monday
9:30am - 12:30pm
3:00pm - 6:00pm
Tuesday
9:30am - 12:30pm
3:00pm - 5:00pm
Wednesday
9:30am - 12:30pm
3:00pm - 5:00pm
Thursday
9:30am - 12:30pm
Friday
Closed
Saturday
Closed
Jaffe Chiropractic
3230 Prosperity Church Road #203
Charlotte, NC 28269
(704) 971-3275