Patient Forms

New Patient Forms

Thank you for choosing Brookview Wellness for your care. Dr. Brooke & Dr. Shelby look forward to meeting you and helping you achieve your best health possible!

CHIROPRACTIC FORMS

Prior to your visit, please fill out the Online Chiropractic Intake form.
Please arrive 15 minutes before scheduled appointment time to complete our in house paperwork.

ONLINE CHIROPRACTIC INTAKE FORM
FUNCTIONAL MEDICINE / NUTRITION PATIENTS

Please fill out the Online Functional Medicine Intake Form as well as the Functional Medicine Questionnaires below. THe questionnaires can be printed and returned to the office, via fax 919-577-2226 or email to info@brookviewwellness.com at least 48 business hours prior to your appointment to be reviewed. If the questionnaires are note recieved 48 business hours before your appointment, it will be rescheduled. 

ONLINE FUNCTIONAL MEDICINE INTAKE FORMFUNCTIONAL MEDICINE QUESTIONNAIRES
MASSAGE THERAPY FORMS

PLEASE NOTE: For your safety we require a note from your primary care provider releasing you for massage if you have any of the following conditions: Any cardiovascular issues, currently receiving chemo or radiation for cancer treatment or history of blood clotting disorders.

MASSAGE INTAKE FORMS
PAYMENT OPTIONS

We are a time of service / cash practice and are out of network with insurance providers. This allows us to provide the care that we as doctors feel is necessary for your condition, rather than treatment that is limited by insurance companies. We offer competitive rates and discounted packages to meet your needs. Also, HSA and FSA cards can be used for your care.


**Even though we do not participate with insurance companies you can submit your appointment receipt for ACTIVE care to your insurance company for reimbursement or to be applied towards your deductible. MAINTANENCE / WELLNESS care is not covered by any insurance company.