Atlantic Spinal Rehab and Wellness clinic offers our New Patient Forms online so they can be completed in the privacy of your own home or office. If you have any questions while you are completing thse forms, please call our office at (910) 395-2774.

Download the necessary forms, print them out and fill in the required infromation. You then have the option of brining them to your consultation or faxing them to our office at (910) 395-2472. AdobeReader® is required for the Member Wellness Registration form. If you do not already have AdobeReader® on your computer, your computer, Click Here to download.

New Patient Health History Form - Required

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!

Download & Print MSWORD Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!