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Welcome to the Imatrix Management Center new patient center!

Arriving at a doctors office for the first time can be a nerve racking experience. Paperwork to fill out, new faces and names to learn, and getting to know your way around the office; this can hit the senses all the at same time causing overload.

In contrast, at Imatrix Management Center our aim is to  remove any  stressor causing unnessesary tension and make you feel comfortable. In this area of the website you will be able to take care of items necessary for your visit prior to arriving, in the comfort of your home.

Check out the 2-minute infomercial from Dr. Anthony at http://www.wwaytv3.com/yh/health/chiropractors/atlantic-coast-chiropractic.

  1. New Patient Offer
  2. New Patient Forms
  3. Your First Visit

Take the Stress Test
The purpose of this stress survey is to determine if any health problems you may be having are due to stress. * indicates required information.

*Name
*Age
*Phone (Home)
*Work
*Address
*City, State, Zip
*E-mail Address
*Occupation
# Hours per week
currently working
Spouse Occupation
# Hours per week
currently working

By completing this survey, you qualify to receive a new patient information packet.

1) Check off any of the following symptoms you have experienced in the past 6 months:

Headache/Tension
Fatigue/Tired
Pain Anywhere in Body
Digestive Disturbance
Difficulty Sleeping
Irritability
Low Back Pain
Neck Pain
Wrist/Hand Pain
Elbow Pain
Shoulder Pain
Hip Pain
Pain Between Shoulders
Knee Pain
Ankle/Foot Pain
Ringing in Ears
Nervousness
Dizziness
Allergies
Tension Across Top of Shoulders
Numbness/Tingling in Arms or Hands
Numbness/Tingling in Legs or Feet
Weight Trouble
Other

Which of the above bothers you the most?

How long have you been bothered by this condition?

Describe how it feels or affects you when it is at its worst.

2) Do the symptoms cause you you to be:
Moody
Irritable
Interrupts Sleep
Restricted on Daily Activities

3) In what ways do the symptoms affect your work?
Difficulty Making Decisions
Poor Attitude
Decreased Productivity
Exhausted at End of Day
Unable to Work Long Hours

4) How does this affect your life?
Lose Patience with Spouse or Children
Restricts Household Duties
Hinders Ability to Exercise or Participate in Sports
Interferes with Ability to Participate in Hobbies or other Desired Activities

If you checked any of the above items, then you could be suffering from:

· Excessive Stress ·
· Structural Misalignment ·
· Pinched Nerves ·

We Can Help You because we gently treat your body, naturally, without drugs to remove the stress and imbalances that Cause health problems.

Would you like to get rid of the problem? Yes   No
If your answer is Yes, there are alternatives available to you. Please check the item most appropriate for you.

I would like to come to Atlantic Coast Chiropractic for a complete evaluation. Please call me to schedule an appointment.
I would like to come to a class on Stress and Wellness.
I would like Atlantic Coast Chiropractic to call me to discuss my health problems before making an appointment.
I am interested in receiving more information from Atlantic Coast Chiropractic.

New Patient Scheduling

Fill out the following form to schedule an appointment with our office. We will confirm the appointment via email.

(Please Note:Your privacy is 100% assured.)
 

* Name:
* Street Address:
* City:
* Email:
* Daytime Phone:
Evening Phone:
Referred By:
Preferred appointment time:
(We will try to accommodate your requested time.)
Time Day Month
am
pm

Optional:

Print and complete required forms to expedite your office visit.

Optional:

Complete the area below if you would like us to check your insurance coverage:











Comments:

Insurance

Most insurance plans are accepted at our office. Listed on this page are some of insurance companies we accept. If you do not see your insurance provider listed, or are unsure of your coverage, do not hesitate to call us. Our staff will verify and explain your benefits before treatment, at no charge.

 

Privacy Policy

Atlantic Coast Chiropractic Notice of Privacy Practices
6841-D Market St., Wilmington, NC 28405

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Atlantic Coast Chiropractic is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.

Disclosure of Your Health Care Information

Treatment
We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. (example)

"On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Atlantic Coast Chiropractic."

"It is our policy to provide a substitute health care provider, authorized by Atlantic Coast Chiropractic to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider's absence due to vacation, sickness, or other emergency situation."

Payment
We may disclose your health information to your insurance provider for the purpose of payment or health care operations.

Workers' Compensation
We may disclose your health information as necessary to comply with State Workers' Compensation Laws.

Emergencies
We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

Public Health
As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

Judicial and Administrative Proceedings.
We may disclose your health information in the course of any administrative or judicial proceeding.

Law Enforcement.
We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

Deceased Persons.
We may disclose your health information to coroners or medical examiners.

Organ Donation.
We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

Research.
We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.

Public Safety.
It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.

Specialized Government Agencies.
We may disclose your health information for military, national security, prisoner and government benefits purposes.

Change of Ownership.
In the event that Atlantic Coast Chiropractic is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

  • You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Atlantic Coast Chiropractic is not required to agree to the restriction that you requested.
  • You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
  • You have the right to inspect and copy your health information.
  • You have a right to request that Atlantic Coast Chiropractic amend your protected health information. Please be advised, however, that Atlantic Coast Chiropractic is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s)and information about how you can disagree with the denial.
  • You have a right to receive an accounting of disclosures of your protected health information made by Atlantic Coast Chiropractic.
  • You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices
Atlantic Coast Chiropractic reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Atlantic Coast Chiropractic is required by law to comply with this Notice.

Atlantic Coast Chiropractic is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: Dr. Anthony Giacalone by calling this office at 910.798.0101. If Dr. Anthony Giacalone is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

Complaints
Complaints about your Privacy rights, or how Atlantic Coast Chiropractic has handled your health information should be directed to Dr. Anthony Giacalone, by calling this office at 910.798.0101 If Dr. Anthony Giacalone is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201

Exclusive Offer

Sign up now for a free consultation!

THIS ---->https://atlanticcoastchiro.com/new-patient-center.html

Office Hours

Day
Monday8am - 12pm2pm - 6pm
Tuesday8am - 12pm---
Wednesday8am - 12pm2pm - 7pm
Thursday10am - 12pm2pm - 6pm
Friday8am - 12pm---
Saturday9am - 11amPhone Call appt.
SundayClosedClosed
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8am - 12pm 8am - 12pm 8am - 12pm 10am - 12pm 8am - 12pm 9am - 11am Closed
2pm - 6pm --- 2pm - 7pm 2pm - 6pm --- Phone Call appt. Closed

Testimonial

Testimonial Coming Soon

Atlantic Coast Chiropractic
6841-D Market St. Wilmington, NC 28405

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