Schedule an Appointment

New Patient Forms

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

CHIROPRACTIC FORMS

Prior to your visit, please fill out the New Patient Intake form ONLINE.
Online New Patient Intake Form
Prior to your visit, please PRINT and complete the following forms. BRING the completed forms to your first appointment. Forms are available at office if needed, please arrive 15 minutes before scheduled appointment time to complete.

 Notice of Privacy Form – HIPPA
 Direct Assignment of Benefits & Authorization to Release
 Patient Financial Policies
 Appointment Agreement
 Medicare Advance Beneficiary Notification – *Medicare Only
 Neck & Back Index – *Medicare Only 

FUNCTIONAL MEDICINE / NUTRITION PATIENTS

In addition to the chiropractic forms, please fill out the following forms before your first nutrition appointment. Print and return to the office, via fax 919-577-2226 or email to them to info@brookviewwellness.com prior to your appointment to be reviewed. Include recent lab work within the last year. 

 Overall Health: Metabolic Assessment
 Brain Health & Nutrition Assessment
 Brain Function Assessment
 Neurotransmitter Assessment
 Children’s Neurotransmitter and Nutrition Assessment

PAYMENTS ACCEPTED

We accept a variety of payments, including cash, check and credit cards. In addition, we also accept most major insurance plans. Please contact us with questions or to inquire about your specific insurance plan. Thank you!

INSURANCE PLANS ACCEPTED

We now only accept cash payments and will work with you to file your claim with your insurance.

Questions? Call us at 919-577-2225