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New Patient Offer: Consultation, Exam, and X-ray (if needed) for only $39!

Dilliard Chiropractic P.C. offers our patient's a short form

for essentials that we will need to set up your file.  The remainder of your paperwork will be completed when you arrive at the office for your first visit.

If you do not already have AdobeReader® installed on your computer, Click Here to download.

  • Download the form, print it out and fill in the required information.
  • Fax us your printed and completed form as soon as possible to FAX# (619) 447-2493
  • or you may Scan and Email them to our email address:  TeamDilliard@gmail.com

New Patient Form

Download the Free AdobeReader®


We strive to provide complete care for our patients. Learn more about all the services we provide.
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We will do our best to accommodate your busy schedule. Schedule an appointment today!
Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.