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Information Form

The DiBella Chiropractic Center is ready to serve you in any way that we can. If you have any questions about chiropractic or acupuncture, please call or email us, or submit the form below. Thank you!

Send me more educational materials about how chiropractic promotes healing and good health.
Lower back pain
Headaches 		Neck problems
Stiffness
Other:
Send me more educational materials about how acupuncture promotes healing and good health.
Smoking addiction
Bronchitis and asthma
 Fibromyalgia
Headaches
Other:
Please have a qualified staff member call to discuss a health-related issue.
First Name:
Last Name:
Street Address:
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Phone:
email Address:
Have you ever used a chiropractor before?
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23YEARS

"I got a chiropractor to come along to the [Patriot] shoot, because they can actually stick you back together within 15 minutes . . . The guy is amazing."
- Mel Gibson, Actor

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© 2007 DiBella Chiropractic Center • 528 Union Road • Gastonia, NC 28054 • 704.867.1010
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