Southeast Chiropractic Patient Center

Forms, Payments, and More

Welcome to the Southeast Chiropractic: The Motion Centers new patient center!

We understand that arriving at a doctor’s office for the first time can be nerve racking. If you’ve never experienced chiropractic care before, you may not know what to expect when you come to our Belmont chiropractic office for the first time. Filling out paperwork, learning new faces and names, and getting to know your way around the office can be an overwhelming experience.
That’s why at Southeast Chiropractic: The Motion Centers our aim is to remove any unnecessary stress or tension and make you feel comfortable during your visit with our chiropractor.
In this area of the website, you will be able to take care of items necessary for your visit prior to arriving. If you have any questions at any time, please don’t hesitate to contact our Belmont chiropractic office at

Download Online Forms

Southeast Chiropractic: The Motion Center offers our patient form(s) online so they can be completed in the convenience of your own home or 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 Health History Forms

Major Medical Intake Forms (also use if no medical insurance)
Download & Print Form

Personal Injury Intake Forms (Auto Accident/Worker’s Comp)
Download & Print Form

Información Personal y Confidencial Del Paciente (en español)
Download & Print Form

Personal Injury Intake Forms (en español)
Download & Print Form

Download the Free Adobe Reader®

Hands holding phone
Credit Card and Credit Machine

Payment Option

Southeast Chiropractic: The Motion Centers believes in the value of wellness care for you and your family and have maintained a pricing structure that allows care for all budgets. Our office participates in most insurance programs. We also accept auto accident and workers compensation cases. For patients who have little or no chiropractic insurance coverage, flexible payment programs can be arranged. To learn more about our payment options for chiropractic and wellness care, you can call our office directly.

Insurance

Most insurance plans are accepted at our office. We accept auto accident, workers compensation, personal injury and most health insurance plans, including Medicare. Since there are so many plans and coverage varies widely, please call us to find out if your plan covers care in our office. Our staff will verify and explain your benefits before treatment, at no charge.

No Insurance

For patients who have little or no chiropractic insurance coverage, flexible payment programs can be arranged. If you have no insurance or do not have chiropractic benefits there is still a way for you to receive the care you need. Many patients pay directly for care, as they discover chiropractic to be extremely cost-effective and affordable.

Health on a Budget

At Southeast Chiropractic: The Motion Centers, we’re convinced that a small amount of your time and money to care for your most important asset–your health–will be far less time consuming and expensive than trying to recover it. If you feel you do not have enough time or money to take care of yourself, please contact us–we can help! The last thing we want is for you to come to our wellness center in crisis. So please, we would like to encourage you to take your health very seriously. As the old saying goes, if you don’t have your health, you don’t have anything. Unfortunately, too many people don’t discover how true that statement is until it is too late.

Our Patients Say

We love hearing from our patients about how chiropractic care has helped them improve their health and well-being. Here are just a few testimonials:

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Healthy Patients
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Years in Business
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Distinguished Awards
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Friendly Staff Members

Make An Appointment

At Southeast Chiropractic, serving Belmont, NC, and the surrounding region, Dr. Snyder is providing the area with a natural approach to healing. We can help with a variety of conditions and use various methods, all tailored to your particular condition. Call us today for more information or to schedule an appointment.