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100 Year Lifestyle Chiropractor in Fort Mill SC
Phone: 803-370-4294
Make Your Health a Priority!

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Patient Forms


We offer our patients form(s) online so you can complete it in the convenience of your own home or office.

Click the link New Patient Online Form below, fill out the form completely and leave no blanks, digitally sign and click submit. Forms will automatically be sent to us and uploaded in our software. (Scroll to the bottom of the forms page to be sure that you can sign forms digitally from your computer. If not, you will not be able to complete the process online and will need to complete the forms in the office)


New Patient Online Form

Notice of Patient Privacy Policy

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.



Terms of Acceptance

Before we get started, it is important to explain some terms that you will here over and over during care at our office.