Fill in this questionnaire and/or upload your referral and you will receive a phone call in the next 24-48 hours to set up your initial evaluation if submitted Monday-Friday. Any submissions made after 1PM on Friday will be completed the following Monday morning.  

Locations:

Garners Ferry          Sunset Blvd

Hours of Operation

This will vary at each clinic.

Garners Ferry
Mon-Thurs              7AM- 6PM           

Friday                       8AM-5PM

Sunset Blvd                Monday                            2PM- 5PM            

Tues & Thurs          7AM-5PM   

There are downloadable versions of our initial paperwork available here as well. 

Notice of Privacy Practices

Assignment of Benefits & Release of Information

Notice Regarding Identity Theft Prevention

Patient Information Form

Dry Needling Consent Form

 
Name *
Name
Phone *
Phone
For most insurances, a referral is required before we can treat you. Ask about Direct Access as a possibility with BCBS
If so, please list here.

*You may also submit a picture or copy of your referral here or fax to (803) 783-1147. 

 

*For more information, please see our FAQs page.