new Patient Information

Please review patient forms & policies prior to your visit.  We have included resources to help you plan your care & know what to expect your first visit.  Please bring your insurance cards, driver’s license (or any government issued picture ID), & your medication list to your first visit.  Feel free to call us with any questions. We look forward to taking care of you!


Guillory Chiropractic provides our patient form(s) online to complete at your convenience prior to your first visit. (Optional)

  • All forms are PDF files and require AdobeReader® to view them.
  • If you need to install AdobeReader® on your computer, Click Here to download.
  • Select form to download, print and fill in required information.  
  • Bring completed form to your first visit.
  • Please call us with any questions.


cancellation policy

In an effort to accommodate all of our patient’s scheduling needs & to manage the effect missed appointments can have on our ability to provide a complete & quality treatment plan, we adhere to the following guidelines:

♦ New patients:  Due to the extended block of time reserved for your first visit, we collect a $150.00 ($120.00 for Medicare Patients) fee to hold your appointment.  This fee is REFUNDABLE minus the cost of your visit & the following conditions are adhered to:

We ask that you please re-schedule your initial visit, if needed within 24 hours before your scheduled time.  Otherwise, the $150.00 appointment holding fee will be non-refundable fee. This also applies to a no-show.

♦ Existing Patients:. If you are a no-show for your appointment and/or no attempt is made to re-schedule, a $75.00 non-refundable fee will be assessed to your account per occurrence. 

♦ You will be notified about your appointment on the business day prior to your appointment, providing you the opportunity to confirm or re-schedule.

♦ Please arrive 15-30 minutes early for your first visit, allowing time to learn more about you & collect the information we need to help you.  

We want to provide you with the best experience possible & will make every effort to accommodate your scheduling needs.

Book or reschedule visit

payment options

Many of our services are covered by insurance.* Please call the office to speak with one of our knowledgeable staff members about your individual coverage. Flexible payment options are available & we now offer financing through Care Credit®.

*Accepted insurance policies, services covered, & payment options are subject to change at anytime.  It is your responsibility to provide us with updated insurance information.  We are not responsible for charges incurred with the failure to do so.