Complete the form

The information you provide will help us determine how best to assist you.










Can you receive texts at this number?
Yes, text works best
No, please call me
Call or text is fine

Which office would be most convenient for you?

West Ashley
North Charleston (Ashley Phosphate)
Downtown Summerville

When did you get hurt?


1. Who are you looking to get care for?

just myself
a friend, family member, or someone else
Both myself and someone else

2. How did you get hurt?


3. Did you go to the hospital?

Yes, I went by ambulance
Yes, but not by ambulance
No, I went to my regular doctor
No, I have not seen anyone yet

4. Do you have a lawyer?

No

Is there anything else we should know about your situation?










© BP Chiropractic Summerville LLC. All Rights Reserved. bpchiropracticsummerville.com, is a direct care facility located in Summerville, South Carolina. The links to information is provided as a resource for those who are interested in discovering other theories and treatments for a variety of conditions. This site, nor anyone associated with this site offers a guarantee of accuracy for any information found on pages linked to by this site. The site strongly encourages you to find a qualified practitioner that you can establish a doctor/patient relationship with. This site is not a substitute for medical care.