English Forms

Download these forms by clicking on each. Fill in the form and bring it with you to your first patient visit.
Complete forms #1 and #2 below ONLY if coming in for treatment due to an auto accident.

  1. English New Patient Auto Accident Questionnaire (1-3 pages)
  2. First Visit Condition Questionnaire (complete all items)
  3. English New Patient Cash/Insurance Questionnaire (complete sections 1 and 2)

*HIPAA rules do not allow patients to email private information. Please do not email these forms.

Formularios en Español

Para acceder a los formularios simplemente cliquear sobre el nombre de cada uno de los formularios abajo listados. Imprima y complete el/los formulario(s) y tráigalo(s) con usted a su primera cita.

Complete los formularios #1 y #2 ÚNICAMENTE si el motivo de su vista es por tratamiento debido a una accidente de automóvil.

  1. Cuestionario sobre Accidente de Vehículo – Paciente Nuevo (Páginas 1 a 3)
  2. Cuestionario sobre Condición Médica – Primera Visita (completar todas las preguntas)
  3. Cuestionario sobre Pago/Seguro – Paciente Nuevo (Página 1 a 2)

*Las normas HIPPA no permiten a los pacientes enviar información privada por correo electrónico. Por favor no enviar estos formularios por correo electrónico.

Why Liringis Chiropractic in Greensboro and Winston-Salem, North Carolina?

Full Service Chiropractic Center

Liringis Chiropractic is a full-service chiropractic center focused on your health and healing – without medication or surgery! At our Greensboro and Winston-Salem chiropractic centers, we’ve been helping patients since 1980. We use natural, non-invasive techniques to heal your body from the inside out.

40 Years of Experience

The chiropractic physicians at Liringis Chiropractic have more than 40 years of hands-on experience. Whether you’re experiencing pain or discomfort in your arms, legs, back, muscles or even internal organs, everything is connected by your central nervous system directly to your spinal cord. Learn more about what to expect on your first visit.