New Personal Injury Patient

Graybar Chiropractic & Rehabilitation Centers offers our patient form(s) online for our new personal injury or motor accident patients. This allows you to fill out your forms in the convenience of your own home or 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. Please call us at (910) 343-5250 if you have any questions!
  

New Personal Injury Patient Form - Required

This lets us know the history and current state of your health and asks some basic questions about your personal injury including your accident history and accident lien. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form (English)
Download & Print Form (Español)