NUTRITIONAL CARE FORMS

BOTH forms are REQUIRED:
** New patient (nutritional) PRINT and COMPLETE

** Symptom Survey PRINT and COMPLETE

** For nutritional evaluation, you MUST BRING ALL MEDICATIONS (if any) with you for testing.  THANK YOU! **

These forms are for structural care:
Printed form:New patient (CHIROPRACTIC) 

Or Online form:
https://www.mychirotouch.com/patientintake/?clientid=LWC0011

and/or

Please complete the forms in black ink.

You may return these forms by fax:  (864) 246-5569
OR simply bring with you.

NOW SERVING YOU IN TWO LOCATIONS IN THE UPSTATE!

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