New Patient Center


Welcome to the Dumayne Chiropractic new patient center!

We understand that arriving at a doctor’s office for the first time can be nerve racking. If you’ve never experienced chiropractic care before, you may not know what to expect when you come to our Burlington chiropractic office for the first time. Filling out paperwork, learning new faces and names, and getting to know your way around the office can be an overwhelming experience.

That’s why at Dumayne Chiropractic our aim is to remove any unnecessary stress or tension and make you feel comfortable during your visit with our chiropractor.

In this area of the website, you will be able to take care of items necessary for your visit prior to arriving. If you have any questions at any time, please don’t hesitate to contact our Burlington chiropractic office at 336-584-4008!

Dumayne Chiropractic offers our patient form(s) online so they can be completed 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.
  • Bring completed form to your appointment.

Pediatric patient form, pediatric-intake-new-patient-intake-form.pdf (Under the age of 15)

New Patient intake form, patient-intake-form.pdf

Personal Injury form, patient-intake-form.pdf

For Personal Injury please print and fill out the attached sheet, and then please fill out the online form below.

Click here for the Personal Injury online form