If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site


You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]
336-786-6095 H


Online Forms

Buttonwood Chiropractic and Acupuncture offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Intake 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!

Both links below include forms necessary for new patients. Please be sure to download and print out both forms to have them completed and available upon arrival for your first visit.

Please note while scheduling your appointment to let us know if you are a Personal Injury patient from an Automobile Accident or workman's compensation. If so there will be additional paperwork upon arrival of your appointment and please make sure to have your Insurance information and your Insurance Adjusters name and information available. For those patients who are not Personal Injury Cases exclude the print out form regarding personal injuries from Automobile Accidents.

Download & Print Patient Intake Form

Download & Print EHR Form

Download the Free AdobeReader®

Exclusive Offer

Office Hours

SaturdayBy Appt.By Appt.
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00am 8:00am 8:00am 8:00am 8:00am By Appt. Closed
6:00pm 6:00pm 6:00pm 6:00pm 12:00pm By Appt. Closed