Online Forms

Donwload & Print Form

Jeter Chiropractic Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Paperwork - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


United Health Care and Aetna Patients Additional Information

Download & Print Form


Chief Complaint Form
Download & Print Form


Consent Form
Download & Print Form


Non Covered Waiver Form
Download & Print Form


Oswestry Form
Download & Print Form


Pain Scale Form
Download & Print Form


Patient Profile Form
Download & Print Form


Verbal Release Form
Download & Print Form



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Office Hours

Our Regular Schedule

Monday:

8:00 am - 12:00 pm

2:00 pm - 5:30 pm

Tuesday:

8:00 am - 12:00 pm

2:00 pm - 5:30 pm

Wednesday:

8:00 am - 12:00 pm

2:00 pm - 5:30 pm

Thursday:

8:00 am - 12:00 pm

Closed

Friday:

8:00 am - 12:00 pm

Closed

Saturday:

Closed

Closed

Sunday:

Closed

Closed

Locations

Find us on the map

Testimonials

Reviews By Our Satisfied Patients

  • "I have been going to Dr. Jeter for many years. From headaches to sleeping wrong, he fixed me right up. As I say, there's nothing like a good "snap, crackle, and pop"!!!!!!!!!"
    Leigh HE. Salisbury, NC

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