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New Patient Paperwork

If you’re a new patient with Proactive Chiropractic, welcome! We’re proud to be part of your journey toward pain relief through chiropractic care.

To help serve you better and to make your first visit with us as productive as possible, we’ve compiled a list of four forms you’ll need to fill out prior to your appointment. Download them using the links below, fill them out and bring them with you.

  • 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.
  • Bring the necessary form(s) to your appointment.

This form helps us obtain your demographic information quickly. It also helps us gather information about your pain and past medical history so we can create a treatment plan that works best for you.

This form gives us permission to treat you and solidifies our promise to discuss any risks involved with your treatment.

This form outlines how your health information will be used in our office and serves as your consent for its use.

This form gives Dr. Khlebopros permission to perform x-rays during your visit.

Contact Us

Proactive Chiropractic and Rehab Center
11010 S Tryon St #112,
Charlotte, NC 28273
(704) 504-1770

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At Proactive Chiropractic, we help you get your health back with great chiropractic care.

Featured Review of Proactive Chiropractic and Rehab Center

"I’m extremely grateful for the care and support I received from Dr. Alek and his whole staff from Proactive Chiropractic and Rehab Center throughout my personal injury case. He is incredibly knowledgeable and took the time to explain every step of my treatment, which gave me a lot of confidence during a stressful time. His compassionate approach made me feel valued as a patient, not just another case. He was always attentive to my needs, ensuring I was comfortable and on track toward recovery. I truly appreciate his dedication and expertise, and I highly recommend him to anyone in need of chiropractic care." - Mirelly D on Google

We’re Proud of Our 4.9 Rating Across 1,000+ Reviews on Google!

CONTACT US

11010 South Tryon Street #112
Charlotte, NC 28273

(704) 504-1770

 

HOURS

Mon 8:00am - 6:00pm
Tues 12:00pm - 6:00pm
Wed 8:00am - 6:00pm
Thur 12:00pm - 6:00pm
Fri 8:00am - 1:30pm
Sat 9:00am - 12:00pm
Sun Emergency Only

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