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If you are an upper cervical practitioner/doctor and would like to submit your practice details for inclusion
in our database please complete the form below.

Please Note: If you are a true upper cervical practitioner/doctor then please feel welcome to add your
practice details to our website. This website is not intended as a general list of chiropractors and is only
for those who have chosen to limit their practice to the precise evaluation and treatment of the upper
cervical spine. We will consider your application and if it meets with our criteria your practice details will
be made live on our website.

* Denotes mandatory fields
Existing ID#:
If you are updating an existing Upcspine.com practitioner record please insert your ID#. To find your ID# locate your listing under your country and state under the menu 'PRACTITIONERS'.
First Name: *
Last Name: *
Title: or
Upper Cervical
Approach/Technique Used:
Practice Name: *
Practice Type:
Practice Address:
Street Address: *
Suburb/City: *
Country: *
State/Province: *
Post/Zip Code: *
Telephone: *
Other Telephone:
E-mail: *
Web Site:
Add Practice logo:
    logos must .jpg format and cannot exceed 100 pixels high or 160 pixels wide
I would like to put an Upcspine.com link on my website above
Additional Comments:
(Note: These will be visible
on your listing)
Upper Cervical Practice Questions:
How much of your practice is Upper Cervical? *
Do you take Precision Upper Cervical x-rays? *
Do you use tilting bucky and headclamps on your x-ray equipment? *
    YES NO
Do you have x-ray equipment on site?
    YES NO
Do you rest your patients after an adjustment? *
YES NO   If 'YES' then How Long (minutes)? *
What subluxation analysis do you use? *
Leg length Analysis
What, if any, instruments do you use?:
Status of UpC technique Certification: *
What was the date of the last seminar you attended on Upper Cervical? *
Who may we contact to support the status of your certification in Upper Cervical?
Contact Name *
Contact E-mail *
What is your vision for Upper Cervical chiropractic?

Same as above
First Name:
Last Name:
Postal Address:
Street Address:
Post Code:
Telephone: *
Other Telephone:
E-mail: *

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three + four = *
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