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100 Year Lifestyle Chiropractor in Stephens City VA
Phone: 540-868-9969
Make Your Health a Priority!

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Patient Forms

Adult Intake Form



Pediatric Intake Form



Insurance Verification Form



If you are new to our office, your first visit will last approximately 30 to 45 minutes. We review your health history, perform a complete evaluation, and discuss your health goals.

Whether you are dealing with an immediate issue, want support in correcting an underlying spinal concern, or using our service to maximize your bodily performance, we will discuss how we can help you achieve your health goals and explain how chiropractic care can help you.

To maximize your time in our office, please download, print and fill out the Intake forms prior to arriving for your appointment.

When will I receive my first adjustment?

As soon as you are finished with your first visit, we will schedule your "Report of Findings" and your first adjustment. This is the most important visit to our office. This is when the doctor will explain what is going on with your body, how chiropractic can help, and the proposed adjustment plan. Come with questions! This is your time to educate yourself and take control of your health! Your first adjustment will immediately follow this Report of Findings.

How much will it cost?

The initial visit, which includes an exam and consultation, is $75. However, every adjustment is $40. To keep our prices low, we are a "fee for service" office. If you decide that you would like to include your insurance company in your health, please download and complete our Insurance Verification Form and bring it with you.



Posture Self Test



Core Strength Test



Pregnancy and Chiropractic (PDF)



Children and Chiropractic (PDF)