BACK IN ACTION 

 CHIROPRACTIC, ACUPUNCTURE AND MASSAGE THERAPY

                                       IN RICHMOND,VA

Back In Action offers our patient form(s) online so you can complete 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.
• Download the necessary form(s), print it out and fill in the required information. Please note there are 2 pages.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

Back in Action New Patient Health History Form:

DOWNLOAD NEW PATIENT INTAKE FORM  - PAGE 1

DOWNLOAD NEW PATIENT INTAKE FORM -  PAGE 2

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!