- We strive to provide high quality comprehensive care for our patients. Learn more about all the services we provide.
Back In Action Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Bring your completed forms with you to your appointment.
New Patient Information Form
Please bring your insurance card (if applicable) and photo identification to your appointment. If you are a minor, please have a parent or guardian accompany you to your appointment.
Download & Print New Patient Forms (Required)
Worker's Compensation Insurance Verification Download & Print Form (if applies)
Personal Injury Insurance Verification Download & Print Form (if applies)
These forms are required by the Health Information Patient Protection Act. If you have any questions as you read through these forms, please don't hesitate to ask.
Full Notice of Privacy Practices Download & Print Form (For your information)
Signature Page (included in New Patient Information above)