{"id":2201,"date":"2024-08-05T16:01:27","date_gmt":"2024-08-05T16:01:27","guid":{"rendered":"https:\/\/brittianchiropracticcenter.org\/charlotte\/?page_id=2201"},"modified":"2025-10-27T20:47:48","modified_gmt":"2025-10-27T20:47:48","slug":"online-forms","status":"publish","type":"page","link":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/new-patients\/online-forms\/","title":{"rendered":"Online Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2201\" class=\"elementor elementor-2201\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7862ac6 e-con-full e-flex e-con e-parent\" data-id=\"7862ac6\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7821eee elementor-widget elementor-widget-heading\" data-id=\"7821eee\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Online Forms<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f145ab9 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"f145ab9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><a href=\"https:\/\/maps.app.goo.gl\/7qgL9ANNaZeUVcfa9\" target=\"_blank\" rel=\"noopener\">Brittian Chiropractic Center<\/a> offers our patient form(s) online so they can be completed in the convenience of your own home or office.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-015723c e-flex e-con-boxed e-con e-parent\" data-id=\"015723c\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ddca0c8 elementor-widget elementor-widget-heading\" data-id=\"ddca0c8\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Charlotte<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b70f12d e-con-full e-flex e-con e-child\" data-id=\"b70f12d\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-7cdf0a2 e-con-full e-flex e-con e-child\" data-id=\"7cdf0a2\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-06ce6d9 e-con-full card-bscss  e-flex e-con e-child\" data-id=\"06ce6d9\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cd8ac96 elementor-widget elementor-widget-image\" data-id=\"cd8ac96\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"449\" height=\"449\" src=\"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/Chiropractic-Lithia-FL-Spinal-Decompression.webp\" class=\"attachment-full size-full wp-image-2806\" alt=\"spinal decompression charlotte\" srcset=\"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/Chiropractic-Lithia-FL-Spinal-Decompression.webp 449w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/Chiropractic-Lithia-FL-Spinal-Decompression-300x300.webp 300w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/Chiropractic-Lithia-FL-Spinal-Decompression-150x150.webp 150w\" sizes=\"(max-width: 449px) 100vw, 449px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cd91c20 elementor-widget elementor-widget-heading\" data-id=\"cd91c20\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Patient Intake<br> Form<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5da174b elementor-align-center elementor-widget elementor-widget-button\" data-id=\"5da174b\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/charlotte\/patient-intake-form\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Click Here to Complete<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-dd1d643 e-con-full e-flex e-con e-child\" data-id=\"dd1d643\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-9d7f4ee e-con-full card-bscss  e-flex e-con e-child\" data-id=\"9d7f4ee\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-89e2db9 elementor-widget elementor-widget-image\" data-id=\"89e2db9\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"2560\" height=\"1707\" src=\"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/pexels-nurseryart-346742-scaled_11zon-1.jpg\" class=\"attachment-full size-full wp-image-8531\" alt=\"chiropractor appointment charlotte\" srcset=\"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/pexels-nurseryart-346742-scaled_11zon-1.jpg 2560w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/pexels-nurseryart-346742-scaled_11zon-1-300x200.jpg 300w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/pexels-nurseryart-346742-scaled_11zon-1-1024x683.jpg 1024w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/pexels-nurseryart-346742-scaled_11zon-1-768x512.jpg 768w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/pexels-nurseryart-346742-scaled_11zon-1-1536x1024.jpg 1536w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/pexels-nurseryart-346742-scaled_11zon-1-2048x1366.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6e5138f elementor-widget elementor-widget-heading\" data-id=\"6e5138f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Patient Intake <br>Form - Bilingual<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fbf1683 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"fbf1683\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/charlotte\/patient-intake-form-bilingual\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Click Here to Complete<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-c9a749c e-con-full e-flex e-con e-child\" data-id=\"c9a749c\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-fee98d1 e-con-full card-bscss  e-flex e-con e-child\" data-id=\"fee98d1\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0b88587 elementor-widget elementor-widget-image\" data-id=\"0b88587\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"740\" height=\"493\" src=\"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/young-couple-traveling-car-sunny-day_155003-22183.jpg\" class=\"attachment-full size-full wp-image-2745\" alt=\"car accident injury recovery charlotte\" srcset=\"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/young-couple-traveling-car-sunny-day_155003-22183.jpg 740w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/08\/young-couple-traveling-car-sunny-day_155003-22183-300x200.jpg 300w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2dd9a9b elementor-widget elementor-widget-heading\" data-id=\"2dd9a9b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Motor Vehicle <br>Accident History\n<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0dccec5 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"0dccec5\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/charlotte\/motor-vehicle-accident-history\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Click Here to Complete<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-361b501 e-con-full e-flex e-con e-child\" data-id=\"361b501\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-3129378 e-con-full card-bscss  e-flex e-con e-child\" data-id=\"3129378\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ddbd7bb elementor-widget elementor-widget-image\" data-id=\"ddbd7bb\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"681\" src=\"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/09\/accident-injury4524.jpg\" class=\"attachment-full size-full wp-image-10321\" alt=\"car accident injury recovery charlotte\" srcset=\"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/09\/accident-injury4524.jpg 1024w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/09\/accident-injury4524-300x200.jpg 300w, https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-content\/uploads\/2024\/09\/accident-injury4524-768x511.jpg 768w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7054a73 elementor-widget elementor-widget-heading\" data-id=\"7054a73\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Motor Vehicle<br> Accident History - Bilingual<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-04b4c55 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"04b4c55\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/charlotte\/motor-vehicle-accident-history-bilingual\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Click Here to Complete<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Online Forms Brittian Chiropractic Center offers our patient form(s) online so they can be completed in the convenience of your own home or office. Charlotte Patient Intake Form Click Here to Complete Patient Intake Form &#8211; Bilingual Click Here to Complete Motor Vehicle Accident History Click Here to Complete Motor Vehicle Accident History &#8211; Bilingual [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":73,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"rank_math_lock_modified_date":false,"footnotes":""},"class_list":["post-2201","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-json\/wp\/v2\/pages\/2201","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-json\/wp\/v2\/comments?post=2201"}],"version-history":[{"count":0,"href":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-json\/wp\/v2\/pages\/2201\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-json\/wp\/v2\/pages\/73"}],"wp:attachment":[{"href":"https:\/\/www.brittianchiropracticcenter.com\/charlotte\/wp-json\/wp\/v2\/media?parent=2201"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}