Dr. Schuler's New Patient Forms

By clicking on the below links you can read my Office Policies and Procedures (includes appointment fees), as well as the New Patient Forms and HIPAA NPP form. New patients are scheduled for a 2-hour time block initially with 2 follow-up appointments, one hour each. Out-of-area patients should plan on spending 2 consecutive days in town so I may follow-up with you the day after (or 2 days after) your initial appointment. Please call the office for information about local accommodations.

Please download the following New Patient Forms to fill out once we have called you and arranged an appointment time.

At least two weeks prior to your appointment –
- eSign or Return signed Form 1.0 to shcnorthcarolina@gmail.com.
To bring in with you during your appointment –
- Form 2A (Male or Female) or 2B for Children Under Age 4
- Form 3.0 HIPAA NPP Form
- Form 4.0 Email Correspondence Form

Please make sure you print the correct forms. If you are not sure please call or email us.

Please submit at least 2 weeks prior to your appointment:

1.0: Office Policies

eSign Office Policies Form

Download Office Policies Form

eSign this form directly or sign and return via email at shcnorthcarolina@gmail.com.

2A : Adult and Children Over Age 4 New Patient History Forms:

Male Patient History Form

Female Patient History Form

Please print, fill out completely, and bring in with you during your appointment along with lab work, supplements, medications, and any orthotics & common footwear.

2B: Children Under Age 4 and Those With Development Delays New Patient History Forms:

Children Patient History Form

Please print, fill out completely, and bring in with you during your child’s appointment along with lab work, supplements, medications, and any orthotics & common footwear.

3.0: HIPAA Notice of Privacy Practice Form:

HIPAA Form

Please print, read, and sign the last page of the form and bring in with you to your first appointment.

4.0: Email Correspondence Form:

Email Request Form

Please sign this form and bring in with you to your first appointment.

Disclaimer: Dr. Bill Schuler is a licensed Chiropractic Physician and Applied Kinesiologist in the state of North Carolina. Information on this website is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine including psychiatry, psychology, psychotherapy or the provision of health care diagnosis or treatment, (iii) the creation of a physician patient or clinical relationship, or (iv) an endorsement, recommendation or sponsorship of any third party product or service by the Sponsor or any of the Sponsor's affiliates, agents, employees, consultants or service providers. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any diseases. If you have or suspect that you have a medical problem, contact your health care provider promptly.