• Skip to main content
  • Skip to footer

Fakhoury Medical & Chiropractic Center

Ocala Chiropractor

  • Home
  • Auto Accident Paperwork
    • Online Auto Accident Paperwork
    • Print Auto Accident Paperwork
    • Intervention Medicine Paperwork
  • Appointments
    • Active Patient
    • New Patient
  • Testimonials
  • Conditions
    • Headaches
    • Low Back Pain
    • Mid & Upper Back Pain
    • Neck Pain
    • Shoulder & Arm Pain
    • Peripheral Neuropathy
  • About
    • Services
      • Chiropractic
      • Massage Therapy
      • Ocala Car Accident Doctor
    • Leave A Review
    • Staff
    • History
  • Resources
    • Veterans
  • Blog
  • Contact

Car Accident? Pain?

Call us

Medical Intake Form

Medical Intake Form

Step 1 of 13

7%
  • MM slash DD slash YYYY
  • Enter your emergency contact with phone number
  • Please list other activities that aggravate your condition
  • DO NOT CONTINUE

    This form is for NON ACCIDENT ONLY. Please return to the previous page and select Accident Intake Form. You will not be able to submit this form.
  • MM slash DD slash YYYY
  • Select all that apply
  • Drop files here or
    Accepted file types: pdf, jpg, png, Max. file size: 128 MB, Max. files: 3.
    • Signature Requirement

    • Reset signature Signature locked. Reset to sign again

    Footer

    Hours of Operation

    Our Office Hours Are As Follows:

    • Monday 7:30 to 6:00
    • Tuesday 7:30 to 6:00
    • Wednesday 7:30 to noon
    • Thursday 7:30 to 6:00
    • Friday 7:30 to 6:00
    • Saturday 7:30 to noon

    Contact Us

    Phone: (352) 351-3413
    Fax: (352) 629-6667
    Address:1009 SW 16th Lane

    Ocala, FL 34471

    Copyright 2015 ·

    Fakhoury Facebook
    Fakhoury Yelp Page
    Fakhoury Youtube Page
    · designed by iWebResults - Sitemap

    Accessibility by WAH
    • About
      • Staff
      • Testimonials
      • Services
        • Chiropractic
        • Massage Therapy
      • Conditions
        • Headaches
        • Low Back Pain
        • Mid & Upper Back Pain
        • Neck Pain
        • Shoulder & Arm Pain
      • History
    • Appointments
      • Active Patient
      • New Patient
    • Auto Accident Intake Form
    • Blog
    • Health Insurance or Self Pay Forms
    • Home
    • Hours Of Operation
    • Intervention Medicine Paperwork
    • Leave A Review
    • Medical Intake Form
    • New Patient Paperwork
    • Ocala Car Accident Doctor
    • Ocala Chiropractor
    • Online Auto Accident Paperwork
    • Our doctors
    • Peripheral Neuropathy
    • Print Auto Accident Paperwork
    • Resources
    • Thank You Page
    • Veterans Choice
    • Website Privacy Policy
    • Before Your First Visit
    • Contact