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 - 6:00pm


Wednesday
9:30am - 12:30pm
3:00pm - 6:00pm


Thursday
9:30am - 12:30pm
3:00pm - 6:00pm


Friday
9:30am - 12:30pm
3:00pm - 6:00pm


Saturday
8:30am - 12:30pm

Jaffe Chiropractic
3230 Prosperity Church Road #203
Charlotte, NC 28269
(704) 971-3275