Online Forms

Atlantic Rehab and Wellness Center offers our New Patient Forms online so they can be completed in the privacy of your own home or office. You then have the option of bringing them to your consultation or faxing them to the office at (910) 395-2474.

If you have any questions while you are completing these forms, please call our office at (910) 395-2774.

New Patient Health History Form - 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

Medical Record Patient Request / Release Form

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

Automobile Accident Form - Auto Accident / Workers Compensation Form

In an automobile accident or incident at work? Links above provide all the information we need to get you started with the best care to your recovery.

Sign-up using the form or call us at 910-395-2774 to take advantage of this exclusive offer.

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