Block Chiropractic & Rehabilitation Center offers our patient forms online so they can be completed in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary forms from the list below that pertain to your visit, print them out and fill in the required information.
- Bring them with you on your first appointment.
New Patient Intake Forms
Completion of these forms help us to understand your health history and the current state of your health. What questions, concerns or goals regarding your health and wellness can we help you with? Let us know — we’re here to help you!
Chiropractic Hours
Mon: 9:00am - 6:00pm
Tues: 11:00am - 6:00pm
Wed: 9:00am - 6:00pm
Thurs: 9:00am - 2:00pm
Fri: 8:00am - 3:00pm
Sat: Closed
Sun: Closed
Tues: 11:00am - 6:00pm
Wed: 9:00am - 6:00pm
Thurs: 9:00am - 2:00pm
Fri: 8:00am - 3:00pm
Sat: Closed
Sun: Closed
Massage Hours & Prices
Jamila Graham, LMT
Tues: 4:30pm - 8:00pm
Thurs: 4:30pm - 8:00pm
Sat: 9:00am - 1:00pm
Gwen Cook, LMT
Mon: 1:00pm - 7:00pm
Angela Purnell, LMT
Mon: 9:00am - 4:00pm
Thurs: 9:00am - 4:00pm
$50 for 30 minutes
$90 for 60 minutes
$135 for 90 minutes
Tues: 4:30pm - 8:00pm
Thurs: 4:30pm - 8:00pm
Sat: 9:00am - 1:00pm
Gwen Cook, LMT
Mon: 1:00pm - 7:00pm
Angela Purnell, LMT
Mon: 9:00am - 4:00pm
Thurs: 9:00am - 4:00pm
Acupuncture Hours
(prices vary)
Kristine Shaw Southern, L.Ac., LMT
Tues: 11:00am - 7:00pm Wed: 1:00pm - 6:00pm Thurs: 11:00am - 7:00pm Sat: 9:30am - 1:30pm
Betty Chang, L.Ac.
Mon: 10:00am – 6:00pm
Wed: 9:00am – 4:00pm
Fri: 10:00am – 6:00pm
Sat: 10:00am - 1:00pm
Tues: 11:00am - 7:00pm Wed: 1:00pm - 6:00pm Thurs: 11:00am - 7:00pm Sat: 9:30am - 1:30pm
Betty Chang, L.Ac.
Mon: 10:00am – 6:00pm
Wed: 9:00am – 4:00pm
Fri: 10:00am – 6:00pm
Sat: 10:00am - 1:00pm
Schedule Appointment
Call us at (301) 476-7575 or click
the button to schedule your appointment! Schedule Appointment
the button to schedule your appointment! Schedule Appointment