Patient Forms

Back-In-Action Chiropractic offers patient forms online so they can be completed in the convenience of your own home or office. You will need to have Adobe Acrobat Reader® installed on your computer to view and print these forms. Click here to download Adobe Acrobat Reader® now .

New Patient Information Form

Please bring photo identification and your insurance card (if applicable) to your appointment. If you are a minor, please have a parent or guardian accompany you to your appointment.

Download & Print New Patient Paperwork


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.

Download & Print Full Notice of Privacy Practices Form

Physician Referral Form

Download this form when seeking a physician referral.

Download & Print Full Notice of Privacy Practices Form

The entire team at Back-In-Action Chiropractic is focused on helping you to move better, feel better, and heal better.
Schedule your appointment today and experience the Back-In-Action difference!