Please choose the correct form for the service you are requesting. All patients must fill out a medical assessment before we are able to schedule you for treatment. If you have not filled out an online form previously, please help us by updating your information, as we are trying to go paperless. If you have any questions, please call 866-691-4427 for the Raleigh office or 910-232-2835 for the Wilmington office.
Please use this form if you are a previous patient of Pure but are trying to help us go paperless! If you are a new patient of Pure, please go back and fill out our New Patient General History and Assessment.