Online Forms

Terms of Acceptance FormVarnville Chiropractic and Functional Health Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • 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.

Varnville Chiropractic and Functional Health Clinic Patient Forms 

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!

Application for Care

Confidential Patient Case History Form

Consent for Use or Disclosure of Health Information Form

Office Financial Policy Form

Terms of Acceptance Form

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