Patient Forms

Hooper-Thurston Elite Chiropractic offers patient forms online so they can be completed in the convenience of your own home or office and will save you about 30 minutes in our office:

  1. You may complete the forms online and email to
  1. You may also print the forms and fill out the information to bring with you to your appointment or fax to us at 252.237.2167

New Patient Health History Form:

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!

This form is for all new patients filling health insurance, medicare, medicaid or self pay (cash).

New Patient Auto Accident Form:

If you have been involved in an auto accident please use the following form to let us know details about the accident and the injuries you received during the accident.

Please bring your police report and any other information that may be helpful to your appointment.

Consent to Treat a Minor Form for Parent:

If your family member who is presenting for treatment is younger than 18, please print and bring in the following completed form.