New Patient
Patient Intake Form
Patient Intake
Welcome to Your Patient Intake Form
Before we get started with your visit, we need some basic info. This helps us speed things up, keep your records accurate, and give you the best care possible.
Please take a few minutes to fill out the form below. It’s quick, secure, and necessary.
Free Consultations Available for New Patients
Take the first step toward natural, lasting pain relief.
Talk with Dr. Faulkenberry about your symptoms and see if our non-surgical, root-cause approach is right for you.