Sea Coast Chiropractic and Wellness offers our patient form(s) online so they can be completed it 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 forms (910.763.2884) or bring them with you to your appointment.
New Patient Health History 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!
Download & Print FormHIPAA Privacy Notice
Authorization & Assignment Form
Member Wellness Registration Form - Optional
This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!
Download & Print FormDownload the Free AdobeReader®
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Would you like Dr. Sean Reese to speak at your company?
Dr. Reese speaks on various topics from health and wellness to nutrition and fitness as well as more specifically designed talks such as ergonomics and work place safety tips. He is passionate about sharing his knowledge to help improve the wellness and safety of our community. Your company could benefit from having Dr. Reese speak. Find out how by contacting Nanci Joplin at 910.392.3100 for further details.
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